Anne Snelgrove: Will my right hon. Friend consider granting a debate on local government capital financing? Although the Labour Government have given local councils, on average,33 per cent. extra since 1997, Swindon borough council still claims that it needs to sell off much-loved capital assets, such as Lower Shaw farm, which is a community resource that local people value. May we debate that so that we can get the truth out into the open?

Jim Devine: Can we have an early debate on the scandal of Farepak, which becomes more intriguing every day? On the "Today" programme on Monday, Sir Clive Thompson said that the company was negotiating a rescue package with Halifax Bank of Scotland in March. At the same time, Farepak was sending out letters to my constituents telling them that they were going to have the best Christmas ever. Hundreds of thousands of decent, ordinary people want to know why, if there were problems in March, they were not notified. Why did the company and HBOS wait until the final payments had been made? More importantly, where has the money gone? Does my right hon. Friend agree thatSir Clive Thompson is the unacceptable face of capitalism and does not deserve to be a knight of the realm?

Jack Straw: I agree about the need to reach consensus, but I say to my hon. Friend that although28 days is now the consensus, it was not the consensus when I introduced the Terrorism Act 2000, when it was extraordinarily difficult to secure just a seven-day period. We have to take account of the evidence: if the evidence is that 28 days is satisfactory, not withstanding our original desire for 90 days, so be it, but if the evidence points to a longer period, the whole House must take account of that.

Tony Baldry: May I draw the attention of the Leader of the House to early-day motion 29?
	 [That this House notes the National Audit Office report on delays in administering the 2005 Single Payment Scheme in England, which lays bare the full extent of the Government's incompetence and the financial hardship it has caused English farmers; believes that English farmers were treated in a deplorable manner; regrets that errors and procedural mistakes in administering the Single Payment Scheme could end up costing each taxpayer £4.30; and calls on the Government to give all English farmers at least 80 per cent. of their due payment by 25th December 2006, helping them to have the financial certainty they need to continue producing the best food in the world.]
	I draw attention, too, to early-day motions 57,50 and 53. May we have a statement as early as possible on the financial failings of the Department for Environment, Food and Rural Affairs, which have hurt many people in my constituency; the incompetenceof the single payment scheme for farmers; the postponement of the rural development programme; and the serious funding cuts for waterways such as the Oxford canal, which passes through my constituency? Why is DEFRA such a shambles, and will the Secretary of State for Environment, Food and Rural Affairs come to the House to explain how the Department will sort out its budget for the coming year?

Jack Straw: I do not think that any post offices have been open at 10 pm, which is when I bought my eggs.  [ Interruption. ] I thought that I had thought ahead, but it turned out that I had not done so.
	It is not the Government's fault that there has been a serious reduction in post office business, and it is not as though we have made gratuitous changes. Indeed, we have provided more than £2 billion of subsidy to support post offices, and much of that has gone to rural post offices. Notwithstanding that support,800 post offices in the most rural areas have fewer than 20 customers a week, which is extraordinary. The reason for the change, which, in many ways, is regrettable, given the role that post offices have played, is the advent of the internet and the fact that people choose to perform their financial transactions differently, thus bypassing the post office. That is something with which we all have to deal, and which any Government would have to face.

BILLs PRESENTED
	 — 
	Welfare Reform

Mr. Secretary Hain, supported by the Prime Minister, Mr. Chancellor of the Exchequer, Secretary John Reid, Secretary Des Browne, Mr. Hanson andMs Harman, presented a Bill to make provision for preparations for the restoration of devolved government in Northern Ireland in accordance with the St Andrews Agreement; to make provision as to the consequences of compliance, or non-compliance, with the St Andrews Agreement timetable; to amend the Northern Ireland Act 1998; to make provision about district policing partnerships; to amend the Education (Northern Ireland) Orders 1997 and 2006; and for connected purposes: And the same was read the First time; and ordered to be read a Second time on Monday next, and to be printed. Explanatory notes to be printed [Bill 7].

Andrew Lansley: I am grateful for this opportunity to open for my party the day of the debate on the Address that is about education and health. We chose those subjects because education and health, and the improvement of our public services, are our party's priorities. In the Queen's Speech of May 2005, it was stated that education was the Government's main priority, but it disappeared in the briefing, and it has completely disappeared this year; it is off the radar screen. Health is the number one priority for us; the Leader of the Opposition has made that absolutely clear. What price security, if we cannot be sure that our NHS is there for us and our families when we are ill and in need? What price hope, if we do not have the hope of high standards in education that people can rely upon?
	Those are our priorities, but they are not expressed in this Queen's Speech. In this Gracious Speech, written by this Government, education has disappeared off the radar screen, and so have expressions of priority for health. That is very curious. We have heard time and again—in business questions, as well as in interventions on the Secretary of State today—that people working in the national health service are worried about the loss of services, about their jobs, about the loss of confidence and morale across the service, and about where they are going and whatthe future holds for them. There was nothing in the Queen's Speech about any of that.
	There was also nothing in the speech about the fact that, since the last Queen's Speech in May 2005, gross deficits of £1.3 billion have been announced for the previous financial year in the NHS, and just last week the Department of Health was forced to admit that the gross national health service deficits in the current financial year are now predicted to be £1.2 billion—and, worryingly, the Department has admitted that the number of NHS organisations in deficit is approaching the same number as were in deficit last year. Is there any indication in the Gracious Speech that the Government propose to respond to that, and to the concerns to which it gives rise? No, there is not.

Andrew Lansley: My hon. Friend makes a very interesting point. In itself, payment by results is not a problem; indeed, it is necessary. When we were in government, we made it clear that we wanted a system in which the money follows the patient. If a hospital does the work, it should be paid for it, but in any rational system one would combine the implementation of payment by results in the hospital sector with a process of demand management in primary care. Of course, when we were in government we implemented hospital sector reforms that incentivised activity, while at the same time introducing GP fundholding, which provided effective demand management in the primary care sector. The evidence on deficits that was given to the Select Committee makes it clear that many NHS managers have experienced centrally imposed change, costs and upheaval, which has destroyed any ability that they might otherwise have had to conduct their business planning.
	During the early part of this year the Department of Health incompetently got the tariff wrong, and it had to be completely changed. One chief executive complained to the Select Committee that changes to the purchasing parity adjustment completely tore up the business planning. Those are precisely the matters that Ministers are responsible for. It is no good their pointing the finger—as the Secretary of State is always doing—at NHS managers, saying that they are responsible for the deficits; the Government are responsible for them. By having a debate on this subject today, we saved the Secretary of State from having to meet the Select Committee this morning—she will have to do so next Tuesday—and offer it an explanation. The Committee said in a previous report that PCT reorganisation would be a costly distraction in the NHS—a claim that she rubbished that at the time. However, last week the Department of Health produced a document stating that one main reason for the deficit is the additional cost of PCT reorganisation.

Andrew Lansley: No, I should finish—[Hon. Members: "No, keep going".] There is always a lot more to say, but I had better stop saying it.
	There are commitments to legislation in the Queen's Speech. I asked the Secretary of State about embryology. There are two important points about the proposals. The first is to recognise that the legislation has been successful since 1990, so the Government would be well advised to take note of how the Conservative Government made it clear at the outset—at the White Paper stage—that the measure would be based on consensus. There should be a free vote, and the Government should not try to drive through the legislation on whipped votes.
	Secondly, abortion and the reform of abortion legislation should not be part of the debate on the human tissues and embryos Bill. Those issues should be tackled separately. I hope that Ministers will take account of the recommendation made by the Select Committee on Science and Technology that the Government should give time to private Members' legislation—the conventional route—to allow discussion of those issues entirely separately from the legislation on embryology and tissues. If the two are brought together, there could be serious complications.
	I ask Members to look back to a debate earlier this year, when we made it clear that we have to tackle the stigma of mental health, and that mental health services should have a priority in the NHS that they have not been accorded. As always, the Government had good intentions at the outset but they have not delivered. It would have been a good idea if the Government had listened to the Ginevra Richardson expert committee in 1998. They produced a Green Paper, a White Paper, draft Bills in 2002 and 2004, a commitment to legislation in the last Queen's Speech and then in March the Minister had to announce that they would not proceed with the Bill. It all collapsed, so we have a commitment to legislation in this Queen's Speech—the Groundhog day speech.
	We need the Government to bring us—preferably to this House, as I have told the Minister—a Bill that genuinely reflects the fact that mental illness is indeed an illness; it should not be treated as part of the criminal justice system. The role of legislation is to secure effective therapy. The proposed measures need an evidence basis, and the example of the Scottish legislation in 2003 should be looked at carefully and positively. We need to ensure that the stigma attached to mental illness is minimised, so we need to ensure that compulsion is used as a last resort, not a first option, and that there is no attempt to incorporate the requirements of the criminal justice system into what should properly be health legislation. That is the test that we shall apply to this legislation, and frankly, so far the Government have not matched up to those requirements in the legislation that they have drafted.
	We have heard a Queen's Speech that says nothing new on health—a Queen's Speech which, frankly, just repeated last year's. We know why. It is because, in the absence of any understanding of where the Government themselves are going, they are paralysed. A Government who are divided are paralysed. The Prime Minister says that he is in favour of choice. The Chancellor of the Exchequer says that he is against choice. The Chancellor of the Exchequer gets up and says that he wants the NHS to be more independent. The Prime Minister gets up and says that he does not want the NHS to be more independent. They are paralysed. The Secretary of State and Ministers in the Department of Health have no influence over this matter at all; their mismanagement of their legislation in the previous Session means that they have no slots, other than for a mental health Bill, in this Queen's Speech. They spend their time sitting down with the Labour party chairman, trying to work out how to wrest some modest political advantage out of the financial mismanagement and the chaos that they are creating in the NHS.
	This Queen's Speech has done nothing for the NHS. Improvement in the public services will not stem from this Government. The improvement of public services will be the priority of the next Conservative Government, and I look for that day as soon as possible.

Judy Mallaber: I know of a number of local examples, from just the past few weeks, of the modernisation of health services under this Government, and of steps to raise educational standards as highlighted in the Queen's Speech. For example, for the past year I have been following the progress of my local newsagent as he struggled to get healthy enough to give a kidney to his sister, who is on dialysis every day. He is now proudly showing off his scars—or rather the lack of them, because amazingly he had a kidney transplant at Nottingham hospital by keyhole surgery. If that is not modernisation, I do not know what is.
	I have a friend who is undergoing breast reconstruction after a mastectomy, which she got astonishingly quickly after a scan and a diagnosis of breast cancer.
	On Monday I saw a new science, art and technology block going up at Mill Hill school at Ripley in my constituency, where the school buildings were scandalously neglected under the Tories. I was also giving out Skills for Life awards to local people, as part of a project that is developing new training rooms at a local resource centre for people with disabilities. It is part of a partnership between my union, Unison, and Derbyshire county council, involving those union learning reps that the Conservatives so bitterly opposed in spite of their apparent commitment to education.
	So I know of many local good examples, but I want to indulge myself today by focusing on health and education in an international context. Specifically, in view of the Government's commitment in the Queen's Speech to continue their focus on Africa, I want to give some examples from the Democratic Republic of the Congo. As a member of the all-party group on the great lakes region and genocide protection, I have been an international election observer there in recent weeks, for the first election in more than 40 years. I was hosted by Christian Aid. The election is widely regarded as the most important in Africa since Nelson Mandela's election as President of South Africa. As I am away on Select Committee business next week and cannot speak in the foreign affairs debate, I cannot miss this opportunity, the day after the provisional presidential election results were announced in the Congo, to speak about the situation.
	There is huge tension in the country, including in the capital, Kinshasa, where some have died as a result of the tension between presidential candidates. That election is key to the future of Africa. It holds enormous potential for the future stability and development of Africa, but comes with enormous dangers of reigniting instability and conflict. Undoubtedly, the foreign affairs debate next week will be dominated by Iraq, Afghanistan and the middle east, but in debate on a Queen's Speech that focuses on security, and on countering terrorism and its roots, let us remember that civil war in the Congo cost 4 million lives and involved six neighbouring African countries, whose rebel troops traipsed over Congo, partly lured by its mineral resources. Let us remember that the current largest United Nations peacekeeping force in the world is in the Congo. Therefore, I may be indulging myself, but I could not let this opportunity go by without ensuring that we talk about this matter.
	Let me return briefly to the themes of the day: health and education. I have been delighted by the work of the Chancellor and the International Development Secretary in launching the international finance facility for immunisation. Every day, 29,000 children die of diseases that are preventable by vaccination, yet immunisation of a child costs just £20. Now the international finance facility is developing a programme to front-load the mass inoculation of children against the five key illnesses, which has fantastic potential to improve the health of children around the world. I remind people of our debate about MMR. It is critical to achieve herd immunity by getting that vaccination done on a mass basis, as we did in eliminating smallpox. That can make a phenomenal difference to the health of the world's children.
	I am delighted by the Government's decision to commit ourselves to universal primary education and to take a new initiative on that—with 19 countries committed to building their capacity to provide it. On my recent visits during the elections in the Congo, I saw for myself just how essential those programmes are, and what an important part they will play if we are serious about doing something about the education and health problems around the world.
	Just a few weeks ago I was in a hospital in Kindu in eastern Congo, surrounded by children and families stricken by those five diseases, which are completely and utterly preventable. I saw children with malaria, which we are going to tackle after addressing the five initial illnesses. I saw a child with meningitis. I thought it a miracle that that child reached the hospital, given that there are only 300 miles of paved road in a country two thirds the size of western Europe. That child was able to get there only because we had that hospital, which could not have existed without the support of Medical Emergency Relief International—Merlin—and the Department for International Development. The election officials told me that it was a lifeline for their area. They could not have provided such facilities themselves.
	For every 1,000 live births in the Congo, 205 children die before they reach the age of five. If we can do something about that, we can really feel proud of ourselves. In my constituency, I am very engaged in all our local problems concerning education and health, but thinking about what is faced in other countries such as the Congo has not half made me come back down to earth and put our problems in perspective and be proud of our achievements.
	When I was with Christian Aid in the Congo, we went up the road calling on about 10 polling stations between Kindu and Kalima. We were greeted by a group of Swahili women, singing and dancing. Their children cannot go to school because it is too far for them to walk. There are few roads. It is impossible for them to get to school until they are about 10. They have been dispersed even further than the distance that we went to meet them. We had to go by motorbikes off a long trail to get to see them. They had been dispersed because of the violence of the then Mai-Mai rebels. They had been burned out of their homes. There was mass rape, and the sexual violence in that country has been appalling. The Mai-Mai are not there now, but people have been dispersed. Of perhaps 40 women, only five had been to school. When we asked whether children died under the age of five, they said, "Oh yes; her child died two days ago." We did not have the heart to ask of what.
	I was curious about the project that we were visiting. DFID paid Christian Aid to run a micro-financing project, lending women the money to buy two goats. I asked the people from Christian Aid to ask in Swahili why people did not lose their goats, because the goats and the pigs were wandering all over the place. I learned something: apparently goats have a homing instinct, like that of cats. They wander around but go home at the end of the day. The women were given goats, which will reproduce and provide them with some capital. That is a great project that we are involved with.
	Once I knew the distances that people travel, the impossibility of those children going to school and the difficulties that they have, I realised how difficult it is for us to get the programmes that we are committed to in that country up and running. We gave a lift to one woman who was heavily pregnant; we must have taken her 30 km. The people who walked to the polling stations covered long distances. How can children get an education? There are all the street children who have been chucked out of their houses because of allegations of sorcery and witchcraft, because of a lack of finance, or because they have been abducted to be child soldiers.
	I am excited by the immunisation programme and by what we are talking about in relation to primary education. However, just as with problems in this country, it will work only if there is good governance. One of my reasons for raising the matter today is that I want to make sure that we focus on it. We can be proud of what we have done. We are the largest European bilateral donor to the Congo. With the international community, we have put a great deal into the elections. We have given a lot of help with civic education and development, but we have to keep on the ball in trying to assist people as they experience the difficult situation that they are in at the moment, after the elections, and as they go forward into the future.
	A number of the themes in the Queen's Speech—education, health, security, dealing with terrorism and climate change, which I will come on to—are international. They are not themes that can be considered only in relation to this country. The Congo is a country that should be able to feed itself—if we did not dump our food on it. It is a country that can provide electricity for the whole of Africa and that has huge resources in diamonds, gold, and coltan, which is used for mobile phones. It has massive resources to be able to do things, which is precisely why it has been plundered and pillaged by the Belgian colonisers, by Mobutu, the dictator, and by the rebel armies that have plagued it.
	Why have the neighbouring countries got involved? They have had an incentive to try to get some of the mining contracts through the international mining companies. It will be hugely difficult to put that right, but we must consider the potential for stability in Africa if we can get stability in that country. Of the neighbouring countries, half a dozen have civil wars and internal conflicts, and their troops have bases in the Congo, or have had. The potential for stability if we can get that country moving is incredible.
	It is important to mention the matter today because the important provisional results of the election were announced yesterday. Joseph Kabila got 58 per cent. of the votes and Jean-Pierre Bemba got 42 per cent. Members of the all-party group have met representatives of both the candidates. The results are being contested. There is a danger of continuing violence: 29 people died in violence in Kinshasa after the first round and several people died at the weekend. Those results have to be upheld by the supreme court. It is important that we keep trying to apply pressure for peace and for them to accept those results. Because of the way in which the results have gone, the losing candidate will have fantastic power and influence in the country. Within a large part of it, he will have a great deal of support through the provincial and parliamentary elections. He will be able to have great influence in that context.
	I was in one part of the country where Kabila was the clear favourite and in another part, last time, where Bemba was the clear favourite. I was astonished that in that massive country—there are 55 million people in a country nearly the size of Europe, with 300 miles of paved road—the elections were run as well as they were. They were more transparent that some other elections that I have heard of recently. Every ballot paper was held up for people to see. The forms were allowed to be copied and given to the witnesses of the political parties, so they can be checked. Any complaints about things going wrong in the election have to be followed through to make sure that people have confidence in the outcome. However, I hope that the presidential contenders do not go back to conflicts, arguments and deaths. We cannot afford that.
	We can be proud of our country's contribution and what we have done to try to assist, but we have to keep a forward-looking perspective. We have to carry on putting effort and work into making sure that the Congo gets through this period and starts to tackle some of the fundamental problems. I and others will seek an Adjournment debate when the results of the election have been confirmed. The issues that we want to raise and that we want to keep our Ministers' continuing attention on include security sector reform. We clearly need a single body to co-ordinate security sector reform. There are problems. If people in the army do not get paid, it is hardly surprising that they pillage, rape and live off the countryside. If the country has not got one co-ordinated security force, if each of the contenders has his own forces, and if there are still the remnants of rebel armies, it is not surprising that there is a problem with peace and stability.
	We also have to look at the issue of natural resources, which have been hugely exploited. Reports have shown that the contracts have been given out in a way that has not been fair and reasonable. That will have to be tackled, but it will be difficult because there are too many interests involved. That needs to be taken on board. It is estimated that the resources are worth perhaps $300 billion over the next 25 years.

Judy Mallaber: That is interesting. I assume that we will get some reports back from the recent events involving China and Africa, looking at precisely that. I am a member of the Trade and Industry Committee and we have been interested in the role of emerging countries. I suspect that we will do more work on China. I agree with the hon. Gentleman.
	The issue of governance and democracy is critical, looking to the future. It may be quite hard, given some of their histories, to know how the leading presidential contenders will react to what has happened with the election and to their future responsibilities, but with provincial and national elections there is the potential to get local people to start to realise that they can put pressure on and demand things. That is important. I am pleased that the Department for International Development is putting work into education about parliamentary procedures and how to work at a parliamentary level, and also that we have done a lot of work with civil society. It is important that we work with those local organisations so that they can stimulate developments locally.
	I must pay tribute to Christian Aid. I was pleased that I went with its representatives on my two visits, rather than just being with the ambassador and people from the Foreign Office, because I saw far more than I would have otherwise. Christian Aid has played a good role in local civil society by trying to educate people about the elections. That process needs to continue.
	In view of the Queen's Speech, the other issue I should mention is forestation. One of the polling stations that we visited was in a tropical rainforest clearing, where we were told that 513 out of 517 potential voters had voted in the first ballot. I am envious of those turnout figures, although I am not sure what lessons we could learn. We could try to make our elections more interesting; special material was provided for everyone to wear for the Congolese elections and the returning officers were kitted out in election robes, so perhaps we should add a bit more entertainment and life to our elections, as that might encourage more people to participate.
	The Queen's Speech highlights the importance of a climate change Bill. Preserving the Congolese rainforest is thus important. There are not many roads in the country, so it is not easy for the logging companies to get to such areas. As soon as there are more roads, that will become easier. It is essential that we put pressure on people and give support to stop deforestation, given its potential effect on the world's climate.
	We need to pursue a number of issues. I started by discussing health and education, but these things are all tied in together. It is scandal that there are children in that country with illnesses that we should be able to prevent and that they cannot go to school. Providing what is needed should be possible, given that country's resources; it certainly should be possible with our assistance. The situation requires us to keep our eye on the ball.
	We spend our time being obsessed about Iraq, Afghanistan and the middle east, which is understandable because they are all crucial aspects of foreign affairs, but we should remember the 4 million people who died and the fact that, in effect, an African world war has taken place. There is potential for stability in Africa. It is the one continent that has been going backwards, which is why we reasserted such a commitment to it in the Queen's Speech. We must thus ensure that we take on board these good governance issues.
	I hope that the contenders in the presidential election do not allow the situation to descend into further conflict, but take the opportunity offered to ensure that any potential flaws in the election are examined seriously and that the result is seen to be fair, and then start to work to put their country right. We must not forget the work that we are doing there. We have put a huge amount of effort into the elections and into trying to make the candidates and the country run them in a way that works. We must maintain our commitment.
	I am concerned that the EUFOR troops—the European troops that back up the UN forces—have reasserted that they will leave that country. I do not think that many people are aware that the UN peacekeeping force there is the largest in the world. We must keep up the work that we are doing so that the children there get the education and health resources that they need and the Congo's resources are used to put it on a good footing. That will assist us in getting stability in Africa. I urge our Ministers and our Government to continue to do what they have been doing well up to now. They must not let the issue slip off the agenda. It must be kept at the forefront of our minds, along with all the other difficult foreign and home affairs.

Steve Webb: It is a pleasure to follow the hon. Member for Amber Valley (Judy Mallaber), who made a thought-provoking, well-informed and, in some senses, sobering contribution about her recent experiences in the Democratic Republic of the Congo. She reminds us of the global context of our debate and I am sure that the House is grateful for her comments.
	I am sure that hon. Members will forgive me if I focus principally on domestic matters, particularly those in the sphere of health. I am still trying to work out from my notes whether the Secretary of State said that the Leader of the Opposition was "pretty lightweight" or "pretty and lightweight"; I suspect that it was the latter, which is a noteworthy way of kicking off the debate. I am not sure, but that might say something about the state of NHS opticians.
	There is one sentence in the Queen's Speech that will probably strike fear into the hearts of the 1.3 million people who work in the national health service, despite the fact that it has not really received any attention. It gives us the promise of—guess what—more reform. The sentence reads:
	"My Government will continue its investment in"—
	we support that—
	"and reforms of, the public services".
	Yet again, we have the promise of another year of reforms. Lord Warner, the Government's Health Minister in another place, was initially given the titleof Minister for delivery. It seemed reasonable for a Minister to be responsible for delivery in the national health service. However, Lord Warner's title has now changed to Minister for reform, because, obviously, reform is an end in itself. I have remarked to him that if I were the Minister for reform, I might wake up every morning thinking, "What can I reform today?" He seemed to nod at that suggestion and implied that he did such a thing.
	I suggest that the Department should have a Minister for leaving things alone for a bit. As the hon. Member for Sunderland, South (Mr. Mullin) said, the NHS has suffered seriously due to permanent revolution. People sometimes say, "All the money has gone in, so why haven't we seen more output?" I would be the first to welcome the progress that has been made and I appreciate the work that has gone into achieving it, but why has not more been done? Part of the reason why is that too many people in the NHS have had to take their eye off the ball to deal with constant reform.
	For example, my hon. Friend the Member for Somerton and Frome (Mr. Heath), who was in the Chamber at the start of the debate, has asked me whether the new primary care trusts are up and running. When I assured him that they were, he pointed out that his PCT had not a permanent chief executive, but an acting one, because the new chief executive was still working for the previous body that was in the process of being abolished. A body that is presumably trying to sort out deficits in its region and to get the Government's health reform agenda in place does not even have a chief executive, despite the fact that it has been created due to yet another reform to a body that was created only a few years ago. Such constant turmoil and reform is undermining the effective spending of the money that has been invested.
	What would be the value of a period of stability? We could—I will use a dirty word here—evaluate the reform that has already gone on, instead of fiddling and tinkering with it, changing it and reforming the reform. When one makes a change, is it not worth determining whether that has worked before changing it again?

Steve Webb: My hon. Friend cites a pertinent example. If one puts something in place, but is then faced with a stricture saying that a specific financial target must be met at short notice, one makes the cut that enables one to meet that target most quickly, rather than making the best cut, the most rational long-term decision, or even the cut that delivers the best service improvements or avoids damaging services. Such instability in services damages the morale of people in the NHS. Many of us will have met NHS employees during the recent mass lobby of Parliament. They gave me the clear message that the Government are doing damage to the goodwill and morale of people working in the NHS, who are its greatest resource. If we undermine their goodwill and willingness to go the extra mile—there is often no financial or professional reward for doing so, given that innovation is regularly stifled—we damage the NHS. Such regular top-slicing cannot go on. We cannot have a situation in which people's budgets are radically altered halfway through the year; that is no way to manage a health service.
	I accept that the national health service will never stand still. No one is suggesting that we set it in aspic. We need a long-term direction of travel, but what should be its key features? We have heard one suggestion from the hon. Member for South Cambridgeshire: that we should have an independent NHS and that is what the Queen's Speech shouldhave introduced. However, I think that that is the wrong answer to the right question. Yes, there is worry about over-centralisation, meddling and constant tinkering—I fully agree with the hon. Gentleman on that—but his conclusion that we should have an NHS board to carry out commissioning independently confuses me, because at the same time he says that he would make sure that drugs such as the bone cancer drug Velcade were available. If his independent board declined to commission such treatments, what would he, as Secretary of State, do?

Andy Burnham: The hon. Gentleman is developing an interesting argument. Does he, like me, find it interesting that the Opposition talk about independence in the NHS when NICE—the body that we ask to take the most complex decisions on behalf of the Government and society on how to use taxpayer's money most efficiently—is the best example today of exactly that. The shadow Secretary of State for Health said on television that he would ensure that Velcade was prescribed. Either one accepts the independent model of NICE, or one does not; one cannot face both ways and pick off certain treatments and technologies. Does the hon. Member for Northavon (Steve Webb) agree?

Steve Webb: I do. The record will show that when an early-day motion is tabled that states "This House disagrees with NICE and we should ensure that drug X is prescribed," I do not sign it. I do not believe that, having set up NICE, we should overrule it simply because sometimes it says no, although I have written to NICE in relation to Alzheimer's drugs and others to probe whether the correct questions have been asked and the proper procedures followed. In Health questions recently I asked the Minister of State to examine the reasons why health services in other European countries reach different conclusions. That is an important and legitimate question. In the cut and thrust of monthly questions, he did not really answer it, but I hope that he will come back to me on it.
	I do not want to dwell too long on the Conservative's hypothetical policy, but what is the alternative? The alternative has to be real local accountability. The Government will cite foundation trusts—the brave new world of accountability in the NHS. The previous Secretary of State for Health but several, the right hon. Member for Darlington (Mr. Milburn), said:
	"NHS foundation trusts will usher in a new era of public ownership."
	He said that they were about
	"relocating ownership out of the hands of a state bureaucracy"—
	he sounds like Jim Hacker—
	"and into the hands of the local community... They will be owned and controlled locally not nationally."
	The reality is anything but that.
	When the hon. Member for Amber Valley was talking about slightly dubious elections, I wondered whether she was thinking of foundation trust board elections, which we have been examining. If that is the governance structure of the future health service—we must remember that every trust will be a foundation trust—I have grave concerns about the existence of proper local democratic accountability in the health service. Let me give a few examples.
	In February 2006, the snappily named Basildon and Thurrock University Hospitals NHS Foundation Trust held elections for 13 governors: nine were elected unopposed, as were four staff governors. Rather than getting people engaged in the cut and thrust of vibrant democracy in which competing views on local health services are aired, the trust could barely get enough people to stand, so it held more elections. A few months later, in April, the trust issued 4,000 voting papers of which 1,000 were returned—1,000, from a population of 310,000. I calculate that one third of 1 per cent. of the people of Basildon chose the governors of their local trust, yet that is what the Government mean by local democratic accountability. I know that local government turnouts are not great, but when we get to one third of 1 per cent., we have problems.
	Were that the only such example, we might say, "Well, that's only Basildon," but it is not. In Gloucestershire in April 2005, 18 of the 20 positions were filled unopposed. In Homerton in September 2006—only a couple of months ago—half of the eight positions were filled unopposed. In August, there was no competition for seven of 10 posts at the Liverpool Women's Hospital NHS Foundation Trust. At the Royal Berkshire NHS Foundation Trust, eight positions were uncontested. In the 2006 elections to the Rotherham NHS Foundation Trust, 12 of the 14 posts were uncontested. The story is the same elsewhere. That is the revolution of democratic accountability in the national health service—the way in which every hospital will be run.
	When people are elected, what do they do? They are not being elected to the board; they are being elected as governors, but the governors are not the people who make the decisions. The board makes the decisions. I have come across trusts that are saying that now they have local people elected as governors, they do not need local authority representatives on the board.The end result might be less local democratic accountability, rather than more. The national health service's direction of travel should be toward real local democratic accountability, not sham accountability, which is what we find in too many foundation trusts.
	Local democratic accountability is different from patient and public involvement. I was slightly confused when the Secretary of State intimated that the Department was seeking legislative time to legislate on patient and public involvement. Do I infer from that that she has not been successful in getting that time? I would be grateful for clarification. From the fact that such a measure was not mentioned in the Queen's Speech, may I infer that she failed to get legislative time? Does she hope to get it, but is not sure of doing so?
	It is indicative of the importance that the Government attach to patient and public involvement that they abolished first the community health councils, and then the newly created patient and public involvement forums—a putative new scheme, but the Government cannot even find time for the legislation that might put it in place. There has been a complete failure of local democratic accountability, and a failure to find parliamentary time for patient and public involvement, and the reason is that the Government think that they know best. They have decided what they want done with the health service, but the public have an inconvenient way of saying something different. That is the problem, and that is why we need greater democratic accountability.
	Another area in which we would like to change the direction of travel is health and social care; we want those two services to work together much more closely. The Under-Secretary of State for Health, the hon. Member for Bury, South (Mr. Lewis), who has responsibility for social care, today made a statement headed "Dignity in Care", which says that there is to be extra money for care homes next year, which is obviously welcome. The money will "further the dignity agenda", and there will be "dignity tests" and "champions of dignity". Who could be against any of that? However, the reality is that, in social services departments across the land, people's serious home-care needs are not being met, because local authorities are up against it and have to restrict the availability of social care. The Secretary of State, in her "It's nothing to do with me, guv," mode, would say, "Well, that's down to councils." Does she accept any responsibility for the fact that growing numbers of elderly and frail people cannot get the care that they need? That is clearly happening, and the restriction is getting tighter.

Steve Webb: My hon. Friend is absolutely right, and that is another reason why budget pooling, and greater co-ordination between health and social care, would mean that money was not shunted from one pot to another, and people were not shunted from one part of the system to another. Instead, the system would be seen as an integrated whole, and the service would be delivered in the way that was best for the individual, not in a way that enabled one organisation to balance its books at the expense of another, as that is not the way to run services. That has to be the direction of travel.
	Two pieces of health legislation were mentioned in the Queen's Speech. One was the draft legislation on embryology. I assume that the Secretary of State for Education and Skills will respond to the debate, and it is only fair to forewarn him that I have a question for him about sperm donation. I do not know whether that is a specialist subject of his, but there is a seriousissue to discuss. The legislation on the anonymity of sperm donors is causing real problems. I visited—ina professional capacity—the infertility services department at one of my local hospitals, and constituents have come to see me about the issue.
	Although I fully understand the thinking behind removing anonymity, it has had serious, practical results. The supply of donated sperm has fallen substantially, because now that they can be named, donors realise that, as each donation can serve 10 families, each of which can have two children, one donation of sperm can generate a maximum of 20 children and, in principle, all 20 could turn up on the donor's doorstep in 18 years' time and say, "Hello, dad." It is hardly surprising that in those circumstances, the supply of donated sperm has fallen.
	A further problem resulting from the loss of donor anonymity is that we do not know whether the child born was created by the donated sperm. If the mother continued to have other partners, perhaps including a spouse or regular partner, we could not always be sure that the donor was the father. It is not yet clear how the Government will ensure—

Helen Jones: I am pleased to contribute to this debate on the Queen's Speech, which continues much of the work that the Government have already begun, and which addresses critical problems that we must face, such as climate change, organised crime and the security of our people. A number of my remarks will be about security, because despite our economic successes, we all know that there is a feeling of insecurity in society. One of the great paradoxes of our time is that although prosperity has risen, and although many people have more material goods than was imaginable just a couple of generations ago, they still feel under threat. That threat may be real, as the terrorist threat is, or it may be a matter of perception. Those kids at the end of the street may be up to no good, but they may just be hanging around with their mates.
	The difficulty for us politicians is that it is often hard to get people to believe in the real threats, such as the terrorist threat that everyone in the House knows exists. Sometimes people may sincerely feel, even in a safe and secure community, that they are not safe in their own homes. Much of the legislation in the Queen's Speech aims to deal with external threats, such as organised crime, antisocial behaviour and so on, but I want to consider some of the other reasons why people may feel insecure, and how we can deal with them. Although that insecurity often manifests itself expressly in a fear of crime, the roots of people's insecurity go much deeper. They relate to the profound changes that society has undergone.
	The world that my parents knew has vanished, and even the world in which I grew up has gone. It was a world where we knew our neighbours, and we often went to school with people we had known since we were born. We might even work with them later, or at least live close to them. When I was growing up, my family did not consist of just my parents and me; my grandparents, aunties and cousins all lived around us. My family, like many others, is scattered around the country, and the sense of security that derived from having one's extended family nearby has gone. People often have to work irregular hours to cope with the demands of a 24/7 society. Having grown up in a household where my father worked shifts, however, I know that some people have always had to put up with that.
	People no longer start a job and expect to do it until they retire—they will change jobs several times. Many communities have altered beyond recognition. That has given us a much wider outlook on the world and enriched our lives, but it has challenged us to learn to live together. It is no use politicians lamenting those changes—they have taken place, and we have to cope with them. The question for us is how we build a society that is sufficiently secure in its beliefs and confident of its values to be able to cope with change and regard it as an opportunity, not a threat. An insecure society, like people who feel insecure, cannot cope with change. Security has an economic foundation, and the Government have achieved a great deal in that regard. In 1997, families in some parts of my constituency were suffering from third-generation unemployment. Children were growing up not knowing what it was like for someone in the family to go out to work. Now, however, the number of people in employment is greater than the proportion in Beveridge's definition of full employment, and we expect another 12,000 jobs to be generated once the biggest industrial development in the region comes on stream. However, people not only need to believe that they are doing well now to feel secure but that they will continue to do so in future. Many people who are in work grew up in a period of recession, and they worry about what will happen to their jobs in future. Some people who are in work suffer as a result of low skills and, certainly in my area, low-paid employment.
	The challenge for us is to assure people that if they lose their job and they have to change work in future they can reskill or improve their skills to move on, so I am glad that the Gracious Speech makes provision for a further education Bill. The Government are the first in a long time to take further education seriously, but may I point out to the Secretary of State for Education and Skills that many of our efforts, for understandable reasons, have been directed at young people? We must think about adults, too, because over the next 20 years, the economy will need an estimated 2 million more workers, only a quarter of whom will be school leavers. The needs of the economy and the individual for security and upskilling must mesh if we are to achieve a greater emphasis on adult skills.
	The Government have done a great deal in that regard, as there are 670,000 more people in FE than there were in 1997. The employer training pilots have given 18,000 people an opportunity to raise their skill levels, but we must do more. We must concentrate on people who are hard to reach and do not have many skills. In doing so, we should learn from what has been successful. Adult and community education are extremely good in bringing back into the system people who have had bad educational experiences in the past; so, too, is the trade union learning reps scheme, which is one of the Government's great unsung successes. We must learn from that success, and pay attention to a sector that enables people to learn things that may not be directly relevant to their employment. The question for us is how we build on that engagement with the education system so that they can move on. We must remember, however, that without that system, those people would never go through the door of a college. We must work with them where they are.
	Another problem is to upskill our existing work force. I hope that the Government will look carefully at the pilots in the north-west and the midlands to allow people to achieve level 3 skills in work. As the number of unskilled jobs declines we will require the work force to have a much higher level of skill, so people's future economic security will depend on such skills. Economic security is not an end in itself—it is a means to an end. Unless we enable people to use that economic security to build good lives for themselves in decent, stable communities, we will fail. As politicians, we face two problems. First, how do we reconcile the needs of the community with growing individualism in society? Secondly, on a related point, how do we build and promote a system of values by which we can all abide?
	Politicians are very good at talking about individuals. We all fight election campaigns on the platform, "What we can do for you and what will happen to you in future". Life, however, is more complicated. The rise of individualism has many benefits, because it allows people to live as they wish and to defy convention, but we need to find a language to talk about the meshing of the individual and the community. Our lives do not proceed along parallel lines—it is not a question of me and everyone else—as our paths cross or merge for a time. Unless I as an individual or anyone else live in a secure community, my life will not be as secure, safe and prosperous as it could be. It used to be easy to explain such things when there were many big institutions, but those institutions have declined, so we must find a new language to talk to people about the things that we need to do for the benefit of all.
	The Government have made several efforts in that direction, but I want to touch on a few issues that need to be addressed if people are to feel secure. First, in the inner cities and areas such as mine where house prices are much higher than in surrounding areas, it is difficult for young people to get a foot on the housing ladder. There is not enough rented accommodation, and the available housing is often of poor quality. I admit that we are schizophrenic about that—we all want our children to have access to good, affordable housing, but we do not want it to be built near us. We must address that problem, because many families fear that their children will not be able to do as well as they did, and they will not get their foot on the ladder because of housing problems. I commend the Government on encouraging more forms of home ownership and on their investment to bring housing up to a decent standard. However, those new forms of home ownership must be spread more widely if we are to tackle the problem.
	We must look carefully at the provision of affordable housing. Quite simply, developers often wriggle out of their obligation to provide affordable housing on developments, but they should not be allowed to do so. We must consider, too, the development of housing tenure, as it has split communities. I grew up on a council estate with mixed communities, but that is no longer the case in many areas, where social housing has become the preserve of the old and the poor. That is a recipe for problems further down the line. We need many more mixed developments of houses for sale and for rent, whether through social landlords, housing associations, private developers or, dare I tell Ministers, local authorities.
	A local government Bill was announced in the Queen's Speech, but it is not simply by changing the structure of local authorities that we will reinvigorate local government. What matters is what they are able to do. When I grew up, the local authority built housing for sale, as well as for rent, and built it where I lived. There is no reason why local authorities should not do that in future.

Helen Jones: Indeed. We must stop weighting the system against action by local authorities. If there is to be real local democracy, we must accept that sometimes people make decisions that we may not want. With regard to housing, in many cases people want to stay with the local authority rather than transfer to other registered social landlords or arm's length organisations.
	Another issue that we need to face is the environment in which many people live. We talk a lot about the environment in general terms, but what people see is what is outside their front door every day. Although the Government have done a great deal through the single regeneration budget, there are still areas, particularly in authorities like mine, where not enough effort has been put into improving the general environment in which people live. Authorities like mine, which include very prosperous areas and very deprived areas, do not come high on the scale of deprivation when they are measured overall. We need to get much more realistic and much cleverer about how we target funding for these matters.
	Environmental problems—litter, graffiti and vandalism—need to be improved quickly, because they take an area downhill. Although the Government have done much to enact legislation to allow such problems to be sorted out, it is often not enforced locally. That is what we need to focus on—not just on environmental factors, but on antisocial behaviour in general.
	I fully support the Government's agenda on antisocial behaviour. I support it because I am sick of decent, hard-working people having their lives made a misery by a minority around them. I am sick of seeing people in my surgery who cannot get action on it. I am sick of passing legislation in the House which is not being used. I have seen examples of people who have waited two years to get anything done about their antisocial neighbours. I have seen people who have filled in nuisance neighbour diaries, which have been lost. I have seen people who had monitoring equipment installed, which failed.
	When I addressed a conference organised by Golden Gates Housing the other week, those were the issues that I raised. I urge the Government not merely to get tough on antisocial behaviour, but to get tough on those who refuse to act on antisocial behaviour. My constituents are fed up with people having tea and bikkies and discussing the respect agenda. What they want is the people who make their lives a misery to be removed from their estates. They would like their lives back. So let us send in the respect squad if we must, but let us penalise local authorities or registered social landlords which do not act, because my constituents cannot wait any longer for them to act.
	As well as dealing with the negatives in our society, we need to encourage the positives. We need to be clear about the values that we stand for. That does not mean resorting to nostalgia or bringing back jingoism. There are values clearly rooted in our history which we all ought to abide by—respect for the rule of law and for democracy, fairness and tolerance. In some parts of the country, though not, perhaps, all, there is a built-in respect for the value of learning.
	Many politicians have made a mistake in the past by believing that those values were somehow the preserve of the few. They are entrenched in the sort of community that I come from. When Lancashire and Cheshire women in the mills fought for the vote, for instance, and—a story that has long been forgotten—when the cotton workers welcomed Gandhi, what were they doing but expressing their belief in the values of fairness and democracy? When the Welsh miners, who are my ancestors on my father's side, put aside pennies from their meagre wages to fund libraries, what were they doing but expressing a belief in the value of learning? Those are the values that we must pass on to our young people. We do it in the home, but we must also be clear about doing it through education.
	The Government have made huge advances in education, but if I have one comment to make, it is this: we should not talk about education only in economic terms. Of course, a good education system must equip people to earn their own living. If it does not do that, it has failed, but it has to do much more than that. It must equip our young people to behave, to learn, to live in a society that encapsulates respect for those values. There are things that money cannot buy, such as respect for other people, a commitment to the service of others, the ability to discuss the great issues of the day, the ability to use leisure.

Michael Fallon: I remind the House of my interests recorded in the Register of Members' Interests.
	I congratulate the hon. Member for Warrington, North (Helen Jones) on one of the most interesting and eloquent speeches that I have heard in a Queen's Speech debate. I almost wholly share her analysis of the issues that face us, and some of the solutions. I hope that what she has said has been taken full account of by those on the Government Front Bench. On one particular issue she must be right—the House has neglected the issue of continuing and further education in recent years. We spend a lot of time in both Houses discussing higher education but we have neglected further and continuing education, and I hope that we can put that right when the new legislation comes before us. I hope that I will be able, with her, to contribute to that. It was a very good speech indeed, which I could not possibly match, and I hope that those of my and her colleagues who are not here will read it with profit.
	There is always something to welcome in the Queen's Speech, and I certainly welcome two particular measures, limited though they are. The first is the measure to deal with long-term pensions. I obviously welcome the legislation to start implementing the recommendations of the Turner commission, but it is limited in two respects. First, from what I understand, the Government do not intend to deal with the central issue of equity to put existing as well as new members of public pension schemes on to a more equal footing with those in the private sector. As I understand the drift of the Government's proposals, those who remain in the private sector will have to work longer and harder well on into their 60s, not least to restore the damage done by the Chancellor's attack on pension funds, while those in the public sector schemes will still be able to claim their fully indexed rights so much earlier. That cannot be right, and if we are to have long-term pensions reform, we will need to return to the issue of equity between the public and the private sides.
	Secondly on pensions, I hope that the legislation will also give us the opportunity to see what we can do to put the longer-term pensions issue on to a more permanent basis. I am struck how in the United States the future of pensions policy is not a partisan matter. There is widespread agreement between the parties in the United States, and it is not an election issue or a major party-political issue. The Turner commission suggested that it might be given some kind of permanence, and that it might become some kindof standing commission. The Governor of the Bank of England has asked us to reflect on how the new successful arrangements for monetary policy might be replicated in other areas of public policy, and long-term pensions policy might well be one of those. It might well be better if we were able to turn to some more independent figure, other than the Secretary of State of either party—perhaps the Government Actuary relabelled as the public actuary, perhaps the pension regulator. I do not know how it might be structured, but when we are considering pensions overall, we need some more independent source of advice. The Government Actuary's Department advises on the various public sector schemes, but that advice is not always published, so does not contribute to the public debate in the way that I would like to see.
	Secondly there is the Bill to legislate for the independence of statistics. That is welcome, though it has been a long time in coming. The Government first promised to introduce an independent national statistical service in their 1997 manifesto. The Green Paper was published back in 1998. It was entitled "Statistics: A Matter of Trust". It might better have been entitled "Statistics: A Matter of Time", because we have had to wait some eight years for the legislation. However, it is welcome, and I will not go into great detail on it, not least because I spoke on this subject at a conference with the Financial Secretary yesterday because I had the honour to be in the Chair for the Treasury Sub-Committee report into independence for statistics, one of the main recommendations of which was that the Government were right to say that the key must be to improve public confidence. But the way to do that is to make the statistics as independent as possible.
	I was a little disappointed with the wording in the Queen's Speech. It says:
	"Legislation will be introduced to create an independent board"—
	that is good—
	"to enhance confidence"—
	that is good, but then come the words—
	"in Government statistics."
	The statistics are not just the Government's statistics; they are our statistics. They are national statistics. Statistics are a public good, not simply for the Government, not simply for users, but also for the public, who, through official statistics, should be better able to measure the performance of those whom they have deputed to govern over them. Those statistics belong to all of us, and that is why it is so important that that new board is properly independent and does establish statistics as a public good. Those are two Bills that I certainly welcome.
	I come now to three specific issues, which are touched on in the Queen's Speech, but which I think need more attention: public service reform, competitiveness and localism. I begin with public service reform. As many of my hon. Friends have said, so much money has been spent and so many new bodies have been created, yet with so little result. In the national health service, trusts are still not free to set their own pay. Through the power of the royal colleges on the one hand, and the power of the trade unions on the other, we still have national rates, terms and conditions and working practices that do not enable the best trusts to vary, differentiate and experiment with different ways of working in the delivery of health care. Community hospitals are back in vogue and, properly, supported by the Government in a welcome White Paper, but that is not properly thought through.
	Local primary care trusts that want to establish community hospitals find that they first have to sort out how the new trust that has just come into existence wants to take account of the overall pattern of community hospitals in the wider area, as well as having to compete for attention with the "fit for purpose" exercise that is examining almost everything else. Furthermore, the growing inflexibility of the private finance initiative means that acute hospitals are in danger not only from the purchasing and commissioning power of PCTs, which can change from year to year, but from the costs of longer leases whereby rental payments have to be paid for 25, 30 or 35 years to come.
	As the hon. Member for Northavon (Steve Webb) rightly reminded us, we have an increasingly demoralised NHS work force—people who were, rightly, encouraged by the Government to train for and to join the NHS. We have all had in our constituencies cases of physiotherapists, midwives and health visitors who cannot find the post that they were originally promised and are denied the jobs for which they trained. Trusts are under such financial pressure that they are tempted to cut out what may be too cheaply labelled as the softer end of the NHS—vital services such as physiotherapy, health visiting and so on, which are important in early identification and early warning as regards health and need.
	I am pleased that the Secretary of State for Education and Skills is still with us. Perhaps he is still wrestling with the policy on the anonymity of sperm donation and the challenge that has been thrown at him, but if he is going to stand for the deputy leadership and deputy premiership of his party he will have to learn to multi-task and to get his head round these various topics. I will not pursue that analogy. To their credit, the Government have delivered more capital spending on education, with gleaming new buildings that are very welcome, if, as my friends sometimes tell me, rather expensive in terms of pounds per square foot and the engineering and design and so on, compared with other buildings in the public sector.
	We have the new buildings, yes, but head teachers and governors and still stuck with the same working practices and terms and conditions that were laid down 20 or 30 years ago. I fully accept that teachers' working hours were laid down by a Conservative Government 20 years ago and that the Secretary of State has had to live with the consequences in terms of primary legislation. However, this Government have been in power for nearly 10 years. No other business or service organisation outside the public sector still has to work on the basis of working practices laid down 20 years ago. I do not understand why heads cannot be free to set their own pay for staff and to change hours and duties where necessary.
	The question of competitiveness was ignored in the Queen's Speech, which makes no reference to the need for a more competitive economy. It refers to a stable economy, but that is not quite the same thing. A stable economy is a necessary condition of our future prosperity, but not a sufficient condition. We need to be more competitive. I am worried that we are slipping down the various competitiveness league tables. Of course, Front-Benchers can bandy about league tables from different sources to prove whether we are fourth, fifth or 11th, and whether our position has worsened. Nevertheless, I want to share with the House the results of an exercise that I ask the Library to do every three or four years—to measure gross domestic product per head, on a purchasing power parity basis to eliminate the differences in market exchange rates, between the United Kingdom, the 24 other European Union countries, the G7 countries, and all 50 of the states of the United States of America.
	Hon. Members may be somewhat surprised to learn of the results. Five EU countries are wealthier than us per head. Much more interesting, however, is the comparison of GDP per head when the UK is ranked with each of the 50 states of the US, which shows that we would come 44th. Only Mississippi, West Virginia, Arkansas, Montana and Oklahoma are poorer than the UK in those terms, while states such as New Mexico, Utah and Arizona are wealthier. That is an extremely alarming position to be in.
	There is no simple answer to reversing that trend, but this Government have certainly made things worse by increasing the burdens of taxation and of regulation. At first, the Prime Minister wanted to place us at the heart of Europe, but then he signed the social chapter. The Government are bending every sinew in Brussels to get out of the impact of the working time directive, which will not only hit businesses and make us less competitive but, as the Government know full well, hit our public services, not least the NHS. It will affect the social and caring services and doctors on split hospital sites such as serve my constituency and result in huge extra costs for the NHS.
	Irrespective of what has been happening in Brussels, the Government have piled on the regulation here at home. The Pensions Act 2004, well intentioned though it was in dealing with the particular problem of the collapse of certain schemes, has added immeasurably to the burden of regulation on British business. I suspect, as I warned at the time, that that makes it increasingly difficult for weaker companies to be taken over by stronger companies and rescued as they were previously. The Companies Act 2006, which we passed a couple of weeks ago—our very own Sarbanes-Oxley Act—has piled on the bureaucratic burden in terms of lists of suppliers, compliance, business reviews and all the rest of it with which company directors will now have to cope.
	The Government talk a good game on localism, and they have bandied around various phrases in recent years. For a while, we had "earned autonomy", but it then turned out that almost no school had applied for it. In the great trust schools revolution, only 50 or so schools out of 24,000 have so far expressed any interest in trust status. That is not a great number. There are only 50 foundation trusts so far—fewer than 20 per cent. of the total of NHS trusts. We do not hear quite so much about "earned autonomy" nowadays, perhaps because of the failure of various trusts and schools to apply for it. The Treasury has a different phrase—the "constrained discretion model". I take the phrase from the book, "Microeconomic Reform in Britain: Delivering Opportunities for All", by the Economic Secretary and his colleagues. On the ground it does not feel like a constrained discretion model because, as the hon. Member for Warrington, North (Helen Jones) reminded us, interference in planning, policing, health policy and housing occurs again and again.
	I shall give two simple examples. When my former local police commander, who has recently retired, was already battling in west Kent with targets that the chief constable of Kent and the Home Office had set for him, the Government office for the south-east suddenly set him a new target. He received a letter telling him that he was underperforming on tackling bicycle thefts. That edict on behalf of central Government was delivered through Guildford to a local police commander who was trying to police his patch.
	This week my district council, which had presented its planning policy—as it had to do—for reference to the Government office for the south-east, received a letter commenting on it. Some of the detail might be of interest to hon. Members. The letter was from the senior planning officer and the title on the letterhead was, revealingly, "Surrey, Kent, East and West Sussex Planning". That gives some idea of the power of the new Government regional offices. The officer is in charge of Surrey, Kent, East Sussex and West Sussex planning, and he writes a letter to interfere with Sevenoaks district council.
	The letter states:
	"On the information before us, our view is that there is no apparent or convincing case to introduce the policy approach outlined in the SPD;"—
	the planning document—
	"that your Council should instead have regard to the emerging PPS3 (and the Barker 1 response) and that, as it is a high demand area...it should consider applications for housing favourably where they meet the criteria".
	It goes further. As well as objecting to the Sevenoaks document, it continues:
	"In view of the serious reservations which we have expressed about this SPD, we would strongly urge you to abandon any further work on the document."
	It then threatens my district council:
	"You should be aware that, should a planning appeal be made on this issue, this letter may be brought to the attention of the Inspector."
	The council had set out a strategy to build more affordable houses in an area that is 90 per cent. green belt, and was on track to deliver the 3,000 or so houses—a target originally set for the 20-year planning period. It was playing its part by proposing several hundred houses each year to comply with the target. Yet an elected council is suddenly told that it must allow any sort of housing because there is high demand, even if it is in the green belt. That is not what I understand by localism.
	As this is the Prime Minister's last Queen's Speech as Prime Minister, I want to say a word or two about him. He and I became Members of Parliament in the same year and we represented the same council area. I believed that he was interested in effecting radical change. Although he did not agree with the objectives and delivery of the Conservative Government and did not always vote with us when we fought to extend opportunity, widen ownership and encourage social mobility, in 1997 I had hopes that he might show us other ways of achieving that agenda. Three times he had the majority to do that, and he had a successful economy in which to introduce the necessary reforms. However, 10 years later, it all appears to have been frittered away. Of 25,000 schools, 50 are interested in trust status. Of 250 NHS trusts, only 50 so far have foundation status. That is a pitifully poor return for10 years of absolute power, billions in public spending and Bill after Bill. For a truly radical Government, we must await the election of the Government of my right hon. Friend the Member for Witney (Mr. Cameron).

Andrew Gwynne: I am delighted to follow the hon. Member for Sevenoaks (Mr. Fallon), who made a thoughtful speech, especially on localism. I pay tribute to my hon. Friend the Member for Warrington, North (Helen Jones)—she is popping out of the Chamber briefly—who made an excellent speech with which I fully concurred.
	I am grateful for the opportunity to speak in the debate. It has not been long since other hon. Members and I had the opportunity to hold a thorough debate on the NHS. Nevertheless, I welcome the chance to contribute during the Queen's Speech debate.
	The major reforms that are now occurring in our constituencies are having substantial—in my view, positive—effects on care, and I welcome that and the fact that the important issues that affect health care in the years to come will continue to be debated in the House.
	The NHS is both a huge institution employing around 1.3 million people, and a vast array of local institutions in every corner of the United Kingdom. It is important to take opportunities such as the one afforded by the debate to highlight local perspectives on the changes. After all, our constituents experience the NHS through local services. It is also important to ensure that our local experiences are expressed in a wider context. I do not, for instance, think that it is acceptable to complain about service rationalisation in areas that have been allowed to overspend their budgets for many years while simultaneously opposing and criticising the increased investment that the Government have championed.
	We hear many conflicting arguments from the Opposition. Conservative Members claim that, if ever back in government, they would introduce an independent NHS body to distribute funds; share the proceeds of economic growth between spending and tax cuts; and ensure that wealthy areas that traditionally overspend have all the resources that they desire. Those are obviously conflicting aims. It will always be impossible to create financial discipline in the NHS if we do not ask primary care trusts to keep to their budgets, just as it will be impossible to retain current service levels if public expenditure is cut by£17 billion, as the Conservative party's policy commission recommends.
	Whether a formula is used to allocate funds or vast sums are spent on a new independent body to do the job, it will always be important for the constituent parts of the NHS to operate within their means. Our aim should surely be to provide the NHS with generous funding so that it continues to offer a world-class service to its patients, free at the point of use, while ensuring that NHS bodies spend their budgets sensibly, in a way that provides the best health care for the most people, and without compromising the resources available for other areas of the country.
	The Government must deliver fairer funding in the future by moving PCTs towards their proper share of NHS resources. It is vital that the NHS is brought back into balance to achieve a fairer funding settlement for our constituents. In the past, overspending organisations had no incentive to improve because they knew that they would be bailed out by underspending parts of the NHS. That is unfair. When we examine the matter carefully, it becomes clear that the overspenders are mostly in areas with fewer health problems, while the underspenders are mainly in the north of England and the midlands—generally areas with far greater health needs.
	If local service rationalisation and reform is necessary to stop overspending in wealthy areas, that must be done. Large organisations with major budget problems will understandably take some time to do that, and the Government have promised support to help them succeed, but they must get back into balance as fast as possible. It is simply wrong to expect the PCTs and the acute trusts that serve my constituents to continue to postpone improvements in care for their patients for the sake of those that continually overspend.
	Although much has been done, health inequalities in this country remain significant, with residents of the poorest urban areas having the lowest life expectancies. New efforts must be made to tackle those inequalities. My constituency of Denton and Reddish has higher obesity rates, more smoking-related deaths and, consequently, lower life expectancies than the English average. It is my job to ensure that the most vulnerable people in Denton and Reddish get the support that they need and it is unfair to continue to ask the Tameside and Glossop primary care trust, Stockport PCT and my constituents to fund overspends in areas where people can expect to live significantly longer.
	The money that the Government continue to invest has delivered vast improvements in health care. Stepping Hill and Tameside general hospitals, which serve my constituents, have received good and excellent ratings by the Healthcare Commission in respect of quality of service and use of resources. Those hospitals were two of only 10 health care organisations in the north-west to acquire that positive seal of approval. I want us to ensure that more hospitals in the north-west of England have the same opportunity to reach that level of care for their patients. In particular, I want to ensure that the Tameside general hospital tackles those areas where it still needs to improve its performance. My hon. Friends the Members for Ashton-under-Lyne (David Heyes) and for Stalybridge and Hyde (James Purnell) and I recently raised those problems with Ministers. There are certainly issues that Tameside general hospital needs to resolve.
	Society is changing and hospitals and clinics will have to spend their allocated budgets in a way that addresses the needs of the patients whom they treat, just as Stepping Hill and Tameside hospitals do. Since coming to power, the Government have increased the number of people working in the NHS by 300,000, but increasing staff numbers and keeping large district hospitals open should not be seen as the end goal. Yes, in many cases, keeping staff numbers high and large successful hospitals open are the best ways to achieve NHS aims, but they should not be seen as ends in themselves. The Government must ensure that the best structures are in place to provide health care to all who need it.
	If NHS money is best spent caring for people in their own homes, rather than in hospital beds, that is what should be done. If money is better spent on small specialist units, rather than on large general hospitals, that is also what should be done. Similarly, if money is better spent on new services at general hospitals, as with the new, improved accident and emergency department at the Tameside that is part of the£80 million private finance initiative at the hospital, or the newly rebuilt Stepping Hill hospital, that is what should be done.
	The Government are putting unprecedented levels of funding into the NHS. Investment has doubled since 1997 and it will have trebled by 2008 to more than£90 billion. That will bring it up to the European average for health care spending, but such an unprecedented level of taxpayers' money has not been injected into the NHS to keep it standing still. It has not been invested to retain services for their own sake. It has been invested so that if more efficient ways of providing health care exist, the NHS can afford to pay for them.
	If we value the way in which the NHS is structured today or was structured 60 years ago more than we value its core values, we will let our patients and constituents down. The NHS is not a museum for outdated methods, but an institution that must be continually reformed as new demands are placed on it. To ensure that the NHS continues to deliver high-quality care, it must respond to changes in patient needs and developments in medical technologies.
	By 2025, the number of British people above the age of 85 will be up by two thirds, with the average 85-year-old costing the NHS five times more than the average 16 to 44-year-old. With an ageing population such as ours, more resources will have to be directed to helping people in their own homes, rather than admitting them to hospitals for long stays. With new technologies to support care at home, it will simply become more efficient to treat patients in that manner.
	GPs in Denton and Reddish are increasingly providing minor surgery. Community matrons are working in Tameside and Stockport to help people better manage their long-term health conditions such as asthma, heart disease and diabetes. That will improve people's health and avoid unnecessary hospital admissions. When people do have to be admitted to Stepping Hill or Tameside general hospital, more procedures are being carried out as day cases. Also, better drugs and rehabilitation mean that the number of days that my constituents have to spend in hospital will continue to decrease.
	Committed, highly trained staff have been integral to the success of both Stepping Hill and Tameside general hospital, just as they are integral to the overall success of the NHS. As I mentioned earlier, there are now about 300,000 extra staff working in the NHS than there were in 1997, including 85,000 more nurses and 32,000 extra doctors. In the north-west of England alone, there has been an increase of nearly 49,000 staff. The extra money put into the NHS has allowed the Government to invest more than £1 billion in improving pay and working conditions across the NHS.
	The minimum hourly pay for all staff is now up by 35 per cent. in real terms since 1997. The starting pay for newly qualified nurses is now £19,166, up from £12,385. Qualified nurses now earn on average £30,890, up from £20,760, and nurse consultants can earn up to £60,000. Front-line midwives can now earn up to £31,000, up from about £19,000 in 1997. In addition, all staff get a minimum of 35 days holiday, which is up from 30 days. The Government have also improved access to flexible working and affordable childcare.
	When we debated the issue in October, some Opposition Members called current NHS productivity into question. Indeed, the shadow Health Secretary did so today. Conservative Members deplored the fact that new investment money had gone on substantial pay increases for front-line staff and argued that those pay increases had not been matched by increased activity. I would argue that, given the indefensibly low wages that NHS staff received before 1997, it was the Labour Government's duty to increase rates of pay. NHS staff deserve the pay increases that they have received since 1997, and it is right to take pride in the numbers of new NHS staff and the fair wages that they now receive.
	Productivity per pound is simply not a useful indicator when assessing NHS wages. In view of wage rates in 1997, it can only be concluded that many nurses were committed to working for their communities in spite of their salaries rather than for them. It may be considered good management by some to get nursing care for the cheapest possible price, but my hon. Friends find that simply unethical.

Simon Burns: I am delighted that a day of the debate on the Queen's Speech has been allocated to health and education. Both are close to the hearts of all our constituents, and both suffer from considerable problems, as well as enjoy successes.
	As the hon. Member for Denton and Reddish (Andrew Gwynne) said towards the end of his speech, we share a common philosophy and principle about the health service. We share a strong belief that the health service should be free at the point of use for all those who are entitled to use it, with the exception of those aspects of the health service that—dating back to the days of Hugh Gaitskell, Nye Bevan, Harold Wilson and John Freeman—have traditionally not been100 per cent. free, such as prescriptions.
	I was interested to hear the Government give a commitment in the Queen's Speech to introduce legislation to provide a better framework for those suffering from mental illness. The recent history of attempts to introduce legislation to update, modernise and make more relevant the Mental HealthAct 1983—which was the last major piece of legislation governing the way in which we treat and look after people suffering from mental illness—has been long and chequered. The proposals have received pre-legislative scrutiny and there has been a draft Bill, which has aroused a considerable amount of controversy in certain quarters. The Government have considered the legislation and Opposition parties of all complexions have voiced their concerns and support where appropriate.
	I am delighted that the Minister of State, Department of Health, the right hon. Member for Doncaster, Central (Ms Winterton) is in her place. However, I do not wish to devote my speech to the ins and outs of the Bill, which is published today, except to say that the overriding desire must be to help to provide the finest treatment possible to those suffering from mental illness, rather than getting the balance wrong and looking at the issue too much in the context of the criminal justice system. However, I accept that there are aspects of mental health care and treatment that will inevitably involve the criminal justice system. We must not lose sight of that.
	The theme on which I want to concentrate initially is in some ways a by-product of the legislation, but to me it is just as important: the way in which society regards those people who are unfortunate enough to suffer from mental illness, and the stigma and fear in society associated with those medical conditions. It was Enoch Powell, back in 1963, who introduced the concept of care in the community, rather than having people locked up in long-stay hospitals, out of mind and out of sight, where their conditions, quality of life and environment were horrendous. The basic ethos of the policy since then has been to integrate people into the community, where they can receive their treatment and live as reasonable and normal a life as everyone else. That is absolutely the right philosophy and guidance to adopt in a civilised society.
	There must of course be safeguards, as the Minister would be one of the first to accept. I, too, was a Minister for mental health many years ago and that duty was uppermost in our minds then. There are still flaws in the system, and they need to be addressed, but that does not mean that we must abandon and compromise the basic principle of care and decide that just because an individual suffers from mental illness, they must be isolated and treated differently from those suffering from appendicitis, flu or cancer. There must be equality, and there must also be protection for those individuals who are a threat to other citizens, but that is a different issue. We must ensure that we have in place a system that can recognise and identify those people who are safe and who should be treated in the community and those people who are a threat to themselves or others and who need a more secure form of residence and treatment. That requirement is not an overriding problem that invalidates the concept of appropriate mental health care.
	If we accept that basic premise of a civilised society, we must consider how to change the public's perception. The public's attitude towards people with mental illness is radically different from their attitude to other acute illnesses. If one suffers, sadly, from cancer or one has flu, there is tremendous sympathy, concern and interest among family and friends—we have all have come across that throughout our lives—but if one suffers from mental illness, however mild, there is fear and a stigma attached, and that starts with the patients themselves. They are fearful of telling people—sometimes, even members of their own families—about their illness because they are frightened of the reaction and the raw prejudice to which they may be exposed. Beyond one's family and friends, members of the public in general may be frightened. They always assume the worst, because they do not understand the complexities and conditions of mental illness.
	Sufferers become the butt of jokes, prejudice and may be shunned and subject to associated ill treatment. Although that has gone on for generations, significant attempts have been made not only by the voluntary and charity sector, which does a fantastic job in providing help, support and practical assistance to the sufferers of mental illnesses, but by Governments to minimise such negative reaction. In the 1990s, my own Government started the process to try to reduce the stigma of mental illness and to break down the barriers. To their credit, this Government have done so, too. It would be stupid to suggest that, on 1 May 1997, all the good work that was being done before then stopped and that this Government have done nothing. It would be equally stupid to claim that everything that this Government have done in that respect from 1 May 1997 has been wonderful and that the previous Government did nothing. We may have started too late—society may have started the process too late—but we made that start in the 1990s, and to their credit, this Government have carried on with that and built upon it.
	We now see genuine attempts by the Government and in communities, through the mental health and community health trusts and the charitable and voluntary sectors and organisations, to work to break down the stigma, the fear and the prejudice; but by definition, that is a very time-consuming and slow process. Of course the Bill will concentrate on the nuts and bolts of mental health legislation—the treatments and all the other associated issues—but I ask the Minister not to forget to carry on the work against fear, stigma and prejudice.

Simon Burns: My hon. Friend picks up an extremely important point that is a crucial part of the equation. In fairness to the Secretary of State for Health, who is no longer present, I was heartened by her response to my intervention on the issue. According to her, such work is going on, rightly so, and I hope that it will be not only successful but applied throughout the work force and to all employers, as well as in the rest of society. That will be a crucial step forward. I will stop there on the issue of mental health, because I hope that there is a common ground on both sides of the House about tackling the problem.
	I should like to raise another issue, which will probably not bring such happiness to the Minister, about the other part of the Queen's Speech that relates to the national health service. It is, by and large, the catch-all phrase that the Government
	"will carry through the modernisation of healthcare based on the founding principles of the National Health Service."
	As I said at the beginning of my speech, I wholeheartedly subscribe, as I have throughout my life, to the founding principles of the health service and I wish and am confident that, regardless of whether it is a Labour Government or a Conservative Government, those principles will be maintained, but what worries me is this inexorable drive towards modernisation.
	I am not talking about modernisation where one embraces new and better drugs, more effective treatments and more effective equipment to treat people—obviously, we all subscribe to that. What I worry about is the constant and inexorable desire of politicians to make changes to the system the whole time, so that we now have a national health service that is basically in a constant state of flux. Again, to be fair, it did not start on 1 May 1997. We, too, as a Government made changes. All Governments, regardless of their political colours, seem to have this desire to tinker, to change everything in the NHS the whole time and to reorganise. I think that the time has come to say enough is enough. It is time for us to allow the changes in the structures to bed down and to allow people to get on with working in the health service, delivering the finest possible health care for our constituents, not wasting money on one reorganisation after another.
	Funnily enough, I visited my national health service GP yesterday for a minor treatment. Knowing that it was the day of the Queen's Speech, he was talking to me about what he thought the Government would introduce in the next Session of Parliament. We got on to the health service. The one plea he made to me was, "Can we please be left alone to get on with doing our job and treating patients, without constantly having reorganisation after reorganisation and change after change, micro-managed from Richmond house?" I think there is considerable sympathy for and merit in that case. We must let the staff get on. A considerable amount of money has been wasted by the constant changes, which are not wanted by local communities.
	The beauty of the PCTs when they first came in was that they were going to be local organisations based on local areas, with local people running them to determine local priorities for health care. I wholeheartedly accept that principle. When the legislation was going through Parliament, I wholeheartedly supported that concept, as a shadow health Minister, and wished the Government well. I thought, as I think in their heart of hearts the Government did at the time, that the size of the PCTs was too small and that that was never going to be a viable size. As I understand it—the Minister can correct me if I am wrong and I do not mean this in a derogatory way—the Government understood that prior to the last general election, but were not going to allow any true mergers until after that election.
	We did see a type of merger, for example, in my own PCT, where we had the same chief executive as the Braintree and Halstead PCT next door, which was a form of merger in that it halved the salary bill for chief executives. However, it was inevitable that, once the election was over, PCTs were going to merge into more viable, realistically sized PCTs. We have probably reached that stage now. Certainly in Essex we have, where fortunately the Minister's Department listened to the lobbying of Members of Parliament and others and the number of PCTs went down from 13 to five, rather than the two that the health community proposed in Essex. That number is probably the right one to be able to be viable, to perform well and to meet the local needs of the community, which will identify with those PCTs.
	Again, ambulance services in the east of England have been merged. The Essex ambulance service has been merged with those in the surrounding counties to form the East of England ambulance service. I do not think that that is a particularly clever idea. Earlier this year, the Home Office backed away from doing it with the police, which I welcomed. It is a mistake and a pity that the ambulance services were merged into one very large east of England regional service, but time will tell. The jury is out and we will have to wait and see.
	The hon. Member for Denton and Reddish seems to think that everything is 100 per cent. wonderful in the health service and that there are no problems. Either he does not fully understand what is going on in his constituency, in mine and in my hon. Friends' constituencies, or some over-enthusiastic researcher in the equivalent of Central Office for the Labour party wrote the speech and he just read it out. Listening to some of it, I thought that it seemed to be totally divorced from reality. The only thing I can say to cheer him up is that I hope that the Whip on the Government Bench was listening carefully because such on-message loyalty to the regime can only help the hon. Gentleman at a future reshuffle.
	Sadly, the wonderful impression that the hon. Gentleman gave is not the experience in Essex and West Chelmsford. We have suffered a double whammy. We have a fine nursing school at the local university, which trains nurses—the health service has been crying out for nurses for a number of years. We have invested in them both financially and in time and in training. They are now trained, have experience and are all ready to put something back into the health service, but a significant proportion of them cannot get any jobs in local hospitals; my local hospital announced six weeks ago that it is losing 245 jobs. We have invested in skills and in training people for an essential vocation—nursing—yet, ironically, they have the frustration of not being able to go into the health service to practise their skills, look after patients and earn a living. That is a callous waste and I am disappointed.
	Because of the deficits both of the Chelmsford PCT and the Mid Essex Hospital Services NHS Trust, three intermediate care wards have been closed. I think that the Minister was in post when they were created. The Government, to their credit, provided funding to set up the wards, which were to relieve the problems of delayed discharges at Broomfield hospital andSt. John's hospital, so that we did not have beds being wasted by people remaining in them whose medical condition did not warrant that. The three intermediate care wards were established. We saw a significant drop in the problems of delayed discharges at the acute hospital and the wards were extremely good, but because of the £13 million deficit at Chelmsford PCT, now all three wards have closed, solely as a money-saving exercise, not because there was no clinical or medical need to keep them open. That is a waste. A good initiative by the Government has been stopped because of financial realities.
	We will spend the next year of this Session discussing the further modernisation of the health service and the provision of the finest, highest-quality health care for our constituents. I ask the Government and Ministers to reflect and not to decide, as all politicians do, that they have to do something about a given problem, as doing something usually means reorganising or changing. It is not always necessary to change. Sometimes, it is better just to sit still and let the existing system bed down, so that it can deliver the services to the highest quality that we could hope for.

David Tredinnick: This is an exciting time to be in the House for Conservative Members, and we should look at the Queen's Speech in that context. We are ahead in the polls—by 10 per cent. Our new leader has a positive rating of 42 per cent. as against the Chancellor's 38 per cent. It is clear that we will win the next general election. As the sun sets gently over the Labour Benches, it will not be long before, when we see Labour Members for marginal seats rising to speak, we shall raise our order papers and say goodbye. Some of us, such as my hon. Friend the Member for Ribble Valley (Mr. Evans), have seen it happen before—the swings and roundabouts of politics.
	Here we are considering yet another Queen's Speech, and I have to say that it looks overloaded and tired to me, but in a spirit of generosity I shall start by thanking the absent Secretary of State for agreeing to meet me and a small delegation—perhaps withthe Minister of State, Department of Health, theright hon. Member for Doncaster, Central(Ms Winterton)—to discuss the pressing problems associated with integrated health care. That issue could have been included in this Queen's Speech, but it most certainly was not.
	It is perhaps no surprise that I will confine most of my remarks to integrated health care, but, if I may, I shall turn first to a local issue. Colleagues in all parts of the House have commented on the primary care trust crisis and the problems arising from reorganisation; indeed, my hon. Friend the Member for West Chelmsford (Mr. Burns) made some valuable points in that respect. The number of primary care trusts in Leicestershire is being reduced, which is affecting Hinckley, in my constituency. The proposed improvements to the new community hospital on the old Sunnyside hospital site were put on hold for re-evaluation. Why? In my view, it was because the hospital is on the fringe of the area. We see the same thing with policing. In cases where the organisation in question is large, it is the police stations—or hospitals—on the perimeter that tend to suffer first. More generally, the health service is having massive problems with procurement, which takes far too long, and there has been a very poor review of contracts, but I will leave that issue to my hon. Friends on the Front Bench, who will doubtless want to comment on it.
	In turning to the importance of integrated health care in the health service, I want to point out to the Minister that since the 1987 Parliament, which is when I first entered the House, there has been a gradual and relentless movement toward improved integration of alternative and complementary medicine into the health service. During that Parliament, we introduced as a private Bill—I did not do so myself, but I sat on the Committee that considered it—the legislation regulating osteopaths, who were seen as being outside the health service. In the 1992 Parliament, chiropractors came forward with a Bill, which was passed successfully. As a result, osteopathy and chiropractic, which used to be seen as out on the wings of medicine in Britain, are increasingly part of its structure and fabric.
	I pay tribute to the Government for looking very seriously at the regulation of acupuncture and herbal medicine—an issue on which Professor Pitillo, the late Lord Chan and others did a lot of sterling work. We will see better regulation of acupuncture and herbal remedies very soon, within the framework of law. That demonstrates the inevitable surge toward integration.
	Those colleagues who recently saw on television the head of a patient in a Chinese hospital being removed for brain surgery using just acupuncture will surely need no further evidence. If one can take off the top of the skull and perform a complex operation using just acupuncture and no anaesthetic—

David Tredinnick: I am grateful to my hon. Friend for bringing that to the House's attention. Such treatments are available on the NHS in some parts of the country, and later in my speech I shall describe the success achieved by a practice in Nottingham that offers a free service to people largely from ethnic communities. However, cost is an issue, which is why we need a wider roll-out of such treatments—I hope that the House will forgive the jargon—in the NHS.
	People want these services. In any high street chemist, one can find ranges of herbal medicines and food supplements, as well as homeopathic medicines with 6C or 30C potencies. People can use such preparations to treat themselves safely. There may be as many as 20 remedies for colds, and all sorts of treatments for stomach upsets. That keeps people out of GPs' surgeries, and improves patient throughput overall.
	Patient demand for such treatments is increasing:75 per cent. of people support NHS access to complementary and alternative medicines, and6 million people use them. When I trawl the House on these matters by means of early-day motions, I find that perhaps one colleague in every three or four will say something like, "My daughter had a terrible problem with spots. We tried steroids and all sorts of strange things but nothing would fix it until we found a practitioner of Chinese medicine." People are always amazed at the results that can be achieved.
	With homeopathy, for instance, a remedy might be so diluted—perhaps one part in 200—that it almost cannot be analysed. In theory, it should be weak, but in fact it gains power from being diluted. I have used homeopathy many times over the years, but I have never been trained in it. Even so, I once looked at the relevant research and prescribed—if I may use the term without insulting the hon. Member for Wyre Forest—a certain remedy for a child who had grommets inserted to deal with glue ear. The treatment was successful after one application, and the problem never recurred.
	There is growing evidence that people want complementary services, and that those services are effective. I shall produce one or two relevant statistics, but not too many—unlike the Chancellor, who in his speeches uses so many figures that no one can understand him. That is one of the reasons why, at the next election, my right hon. Friend the Leader of the Opposition is going to trounce the Chancellor, if that is who he has to stand against. My right hon. Friend always speaks gently and persuasively, and manages to say so much with so few words.
	There is no need to call me to order, Madam Deputy Speaker, as I shall not go down that track—although I suppose that it is in order, given that this is the Queen's Speech debate! I can say what I like about the Chancellor—in which case, let me say that I loathe his delivery. His is one of the most tiresome and repetitive styles ever witnessed in the House, and it compares unfavourably with that of the former Conservative Chancellor Lord Howe. His speeches were built around three or four main points, and we listened with care and interest.

Richard Taylor: It is a pleasure to follow the hon. Member for Bosworth (David Tredinnick) and I can reassure him that in the cancer units that I know, acupuncture, aromatherapy and reflexology are routinely used. However, I have to take issue with him about irritable bowel syndrome. The manoeuvres that he mentioned—colonoscopy and sigmoidoscopy—are not part of the treatment. They are necessary in the diagnostic work-up, before one can begin to treat irritable bowel syndrome, because it is a diagnosis of exclusion.
	I welcome the comments from the hon. Member for Bristol, North-West (Dr. Naysmith), who is an expert on the draft Mental Health Bill, having served through many sittings of the Committee. I shall study his comments and talk to him before deciding my reaction. I welcome the contribution of the hon. Member for Warrington, North (Helen Jones) and particularly her tribute to the good qualities of our young people, which I echo. I also welcome the fact that the Government have included in the programme educational reform that will continue to raise standards in schools. The educational reform taking place on my patch is proving extraordinarily difficult and there are tremendous problems to overcome.
	Before I talk about the modernisation of healthcare, I must join the argument about job losses and staff reductions. Like my eminent predecessor,A. P. Herbert, I sometimes see myself as a referee between the warring factions on either side. What we need in the case of job losses, or staff reductions—whatever we call them—is the truth. The Conservative Front-Bench health spokesman, the hon. Member for South Cambridgeshire (Mr. Lansley), began to try to unravel the patterns. We have to separate compulsory redundancies, voluntary redundancies, retirements when people are not replaced, promotions when people are not replaced, the vacancy freeze, and natural turnover. My acute trust has a natural turnover of approximately 10 per cent., which is 450 jobs. If those are not replaced, that means 450 fewer people doing the work. We need a list of the 300,000 new posts, which the Government cite and which I do not dispute, broken down into clinical staff and administrative staff—we need the detail—and they should then be matched with all the categories that are being reduced because of the various sorts of staff reduction.
	I want to talk about two aspects of the modernisation of health care in particular: the National Institute for Health and Clinical Excellence and hospital reconfigurations. NICE has been much maligned recently, particularly because it appears to be stopping extraordinarily useful drugs getting to patients, and appears to be impeding innovation. It is partly responsible for the UK's slow uptake of new drugs, which is not half a bad thing when one considers the speed with which Vioxx was taken up, and the problems that that caused.
	I strongly support NICE, but several criticisms of it can be made. Does it do everything right? Does it get the selection of expert advisers right? The technology appraisal committees are all generalist in nature, so they must depend on expert advisers; the system must be absolutely right. Is the NICE process as fast as it should be? Is the method of selecting the therapies that it examines appropriate? Somehow we must allow it to approve more drugs for use, which means lowering the cost-benefit ratio so that drugs to combat diseases such as Alzheimer's become affordable.
	There is a great deal of discussion about drugs for wet age-related macular degeneration. I believe that they will cost about £6,000 a course, per patient. The chief executive of my primary care trust tells me that this will cause such a crisis in the NHS that it could well lead to a major rethink of the role of NICE and the way in which it works.

Richard Taylor: I agree with the hon. Gentleman. It is odd that NICE's equivalent organisation in Scotland seems to get its answers out much more quickly. That situation needs to be addressed.
	I return to the impact of affording the treatment for wet age-related macular degeneration. My PCT's chief executive tells me that providing such treatment would cost Worcestershire alone £1.5 million a year, which, taken across the country as a whole, would mean a figure of about £150 million.
	The answer is not to weaken NICE. I am sure that many hon. Members will have seen the dramatic headline in  The Guardian a few days ago, "Open up NHS to our drug firms, White House demands". We should not be swayed by that sort of pressure. There are ways in which NICE could have a lower cost-effectiveness ratio and thus be able to recommend much more in the way of treatment. This all comes down to the terrible phrase that we are not allowed to use, "health care rationing". It is better to use the euphemism "resource management" in health care. We could free up money to be used for more in the way of drugs.
	Many PCTs negotiate commissioning policies with clinicians and patient representatives. In a way, they are rationing, or allocating priority to, their limited resources already in subjects such as aesthetic surgery, and, in the case of my PCT, in respect of radiofrequency ablation for liver cancer, vacuum-assisted wound closure therapy and so on. Such resource management initiatives should be nationwide, and subject to public debate. Should we be paying under the NHS for tattoo removal, for treatment for male pattern frontal baldness, or for anti-smoking pills?
	The Government have made a start by producing an invaluable document, "NHS Better Care, Better Value Indicators", which goes through a range of procedures comparing the efficiency levels of primary care trusts and acute trusts. It measures things such as reducing length of stay, eliminating operations of doubtful value, increasing day case rates, variations in emergency admissions, and so on. If all trusts could be lifted to the standards of the best performers a lot of money could be saved.
	Most dramatic and easiest to understand issection 3.1 of the document, which every MP should read. It is about the use of statins. I guess that many hon. Members are already on statins, and most of us will be at some point in our life, because their effect is dramatic. The Department of Health has studied the rate of low-cost statin prescribing. The first two statins are now off patent and cost a fraction of the others. The introduction to the section states:
	"The volume of statin prescribing has increased several fold during recent years and there are large cost differentials between the different statin drugs. By ensuring that clinicians initiate patients on one of the lower cost drugs, PCTs can keep statin prescribing costs down."
	In 2005-06, statins cost about £500 million. The survey is of all PCTs and measures the percentage of low-cost statins they prescribe. The rate in the best PCTs is84 per cent. At this point I have to praise my local PCT, which is second best, with a rate of 82.7 per cent. The worst is Rochdale PCT, where the rate is 19.2 per cent. The difference between the best and the worst is huge.
	I looked up the statistics for the constituencies of Health Ministers. If the Doncaster PCTs increased their rate of low-cost statin prescribing to 69 per cent., which is the figure achieved by the top 25 per cent. of PCTs, Doncaster could save £967,000. If the Leicester PCTs did the same, £917,000 could be saved. Bury PCT ranks 298th out of 303 PCTs in the survey; it could save £1.2 million. Ashton, Leigh and Wigan PCT is 291st on the list; it could save more than £2 million simply by raising itself into the top quartile. Whole parts of the country, such as Lancashire and the surrounding area, are not doing especially well.

Michael Penning: On primary care trusts that seem to spend extravagantly when they could cut costs, does the hon. Gentleman think that that has anything to do with the situation in places such as Leicester, where, as the Secretary of State has admitted, £1,300 a year is spent per person? In my constituency we get only£960 per head, even though we do very well on prescribing.

Richard Taylor: I think that the same applies, although I must admit that I have not looked at the figures in detail. Many of the midwife-led birth centres will be in community hospitals, and so are probably more likely to be in Conservative or Liberal Democrat constituencies, but I have not looked into the matter in detail.
	To return to hospital reconfigurations, we have to accept that some changes must occur. Given the European working time directive, changes in medical practice and health service deficits, not all acute hospitals can keep all services, particularly when they are close to other acute hospitals. In the past fortnight, I have been lucky enough to have a meeting with the Health Secretary and the chief executive of the NHS, because I regard myself as one of the few people who know absolutely how not to undertake a hospital reconfiguration. I told them that the sort of thing that happened in my area—the loss of all acute in-patient services, and the total loss of accident and emergency services and any practical emergency facilities—would never be acceptable. I told them that people want fairness; they want the pain of reconfiguration to be borne equally. They understand the need to travel to treat rare and complex conditions, but they wish common emergencies to be treated closer to home.
	Since we were drastically downgraded, there have been lesser downgradings, which I have mentioned. The changes at Hexham and Bishop Auckland are much more likely to be acceptable. At my meeting with the chief executive of the NHS I learned something amazing about a tiny hospital in Yorkshire. When he was chief executive of the Doncaster Royal Infirmary NHS trust he oversaw the merger of the tiny Montagu hospital at Mexborough with Doncaster royal infirmary, but he made sure that the Montagu retained medical admissions. In 2000, however, we were told that it was quite impossible for our hospital to do so. The tiny Montagu hospital has 115 beds, including 56 for medical admissions and 16 for rehabilitation, three physicians and five senior house officers—so it is possible to offer such services. The chief executive of the NHS says that many hospitals must be altered, but he oversaw a merger that did not rob a tiny hospital of everything, and kept various services that we all want. Indeed, far more was kept than was kept at Kidderminster. The bulk of emergencies are medical emergencies, so if a hospital accepts such admissions it sees most people who would otherwise go to a full accident and emergency centre. Reconfigurations and mergers can be managed so that they work and are more acceptable than those that took place in my patch.
	The Gracious Speech states:
	"My Government will carry through the modernisation of healthcare based on the founding principles of the National Health Service."
	The Government's view of those founding principles is distinctly different from other people's. They certainly think that the NHS will remain a national health service provided that patients receive free treatment. Many people in the NHS want to go much further, as they believe that unity of providers, rather than competition, is what Bevan wanted. A personal view was expressed in the  British Medical Journal on23 September by Ian Greener, who is not a doctor but a senior lecturer at the centre for public policy and management at Manchester business school. Nearly60 years after Bevan, he said:
	"we find ourselves with a government committed to changing Bevan's NHS to a form its founder would surely struggle to recognise."
	He continued:
	"These reforms seem more radical than commentators in this journal dared imagine...If we add in the vagaries resulting from the PFI process, then we have a reform agenda that seems to sweep away Bevan's NHS across the board, blurring the boundary between public and private not only in financing the service but also in the provision of care".
	I appeal to the Government to protect the National Institute for Health and Clinical Excellence, to look at criticisms that have been made, to expand resource management to make more money available, to carry out reconfigurations and mergers sympathetically, and to slow down reform. I shall check  Hansard carefully, as I am sure that the Secretary of State responded to an intervention from a Labour Member by saying that the Government expected a period of calm in the NHS. I take that to mean that she thinks that the pace of reformation and change in the NHS should slow down. I certainly hope so.

Michael Penning: I am pleased that the Minister of State, Department of Health, the right hon. Member for Doncaster, Central (Ms Winterton) has returned to the Chamber because, unusually for me, I am about to praise her. I congratulate her on the mental health Bill that is to be introduced, on which my colleague on the Labour Back Benches, the hon. Member for Bristol, North-West(Dr. Naysmith), worked so hard on the Health Committee and the Regulatory Reform Committee on which he serves. He is truly an expert in the field. I hope that much of the work that has been done on previous Committees is incorporated into the Bill that will come before the House.
	One aspect of mental health provision is particularly important. It is right that we do not have the sort of Victorian institutions that I grew up around. The Runwell hospital in Essex, which was close to my home and where many of my friends used to work, was an appalling institution where people were sent for reasons that had nothing to do with mental health. It was right and proper that care in the community was introduced.
	However, I have raised with the Minister previously my grave concern that at times people need help which cannot be delivered in their homes or in the community by their local GPs and other experts. Very often, people want to admit themselves to a ward, not only to get the help that they need, but so that their carers can get the help that they might need at times. Sadly, some of those wards are under threat as a result of the deficits in some mental health trusts—not least St. Julian's ward in St. Albans in south-west Hertfordshire.
	So many of the patients and carers to whom I have spoken need such wards as a safety net. The wards need not be full every day or every weekend, but they should exist as a facility so that when care in the community cannot quite cope with individual cases, patients can be admitted to a ward. In the vast majority of cases, those are self-admissions. There is a great deal of fear out there that we pushed too hard down the avenue of care in the community, believing that everything could be done outside a ward—often outside a secure ward.
	There is also fear—ill-founded in many cases—that people who go into a ward are a danger to the public. Very often, they are admitted because they are a danger to themselves, and they know it. That is a difficult mental health issue, as I know the Minister recognises. Although I praise the work that has been done and look forward to the Bill, the contraction in secure wards must not go too far, or we will have even more problems in the community. I am pleased to see the Minister nodding, indicating that that will be looked at.
	Before I go on to speak about the circumstances in my constituency, I shall deal with another aspect of health that worries me greatly: health in the armed forces. I have the honour of participating in the armed forces parliamentary scheme, and I also had the honour of serving in the Army when I was much, much younger. I recently visited the Army recruiting centre down on Salisbury plain. A matter of grave concern is the shortfall of about 7,500 servicemen, especially in the infantry and the Royal Artillery. Furthermore, almost 10,000 servicemen and women are sick and unable to be deployed on operational duties. That is a huge figure for a standing Army of fewer than 100,000. Together, those numbers mean that about 17,500 servicemen and women are unavailable for operational duties.
	If the contraction of medical services in the armed forces continues, that will place an increasing burden on the health service. I asked the senior generals in charge: who was signing off the soldiers—who was responsible? Was it the medical officers in the armed forces?

Michael Penning: My hon. Friend makes a good point. When we return to power at the next election, we will empower local authorities and local people to ensure that that sort of thing does not happen. At present, sadly, the Secretary of State is in charge of the future of my local health service. The Minister keeps nodding and wittering from a sedentary position—if he would listen for a while he might learn something about what goes on in local democracy.
	For months, letters have gone to the Secretary of State asking her to intervene. She has the power to appoint the chairman and the chief executive of the trust and to remove them if she is not happy.The Government have been complicit throughout with the proposals to close the vast majority of the hospital. Nevertheless, there was a consultation process, because that has to take place under the legislation. The results of that consultation were announced a few hours ago in Watford at the meeting of the board of West Hertfordshire Hospitals trust. Eighty-five per cent. of respondents said, "Leave Hemel Hempstead hospital alone—we do not want it to close." Yet the chief executive of the trust stood up and said that he wanted to go ahead with the proposed closures.
	Such closures and amalgamations are devastating for a local community. I agree with the hon. Member for Wyre Forest (Dr. Taylor), my colleague on the Health Committee, who talked about keeping local services local. We hear a lot about choice in the health service these days, but there is no choice if one has nowhere to go. Under the proposals that are being nodded through by the board, the chief executive will order the removal of all acute services from Hemel Hempstead hospital to Watford general hospital. By the way, I should add that Watford is one of the few places left in Hertfordshire with a Labour MP. Elective surgery will go to St. Albans. All the services of a full general hospital, which was built for the new town that was its community—not all constituencies represented by Conservative Members of Parliament are rural; mine is a new town with some serious social and economic problems on the estates—will go. If we are lucky, we may be left with an out-patient and diagnostic department.
	Hon. Members may be interested to know that the trust has already been in discussion with developers, and that an informal meeting took place with the local authority—representatives of which had to attend, whether they wanted to do so or not—about redevelopment and building houses on the hospital site. When the Secretary of State goes on and on about local engagement and involvement, it is frankly a sham. The decisions are based purely on financial deficits.
	At a public meeting, when I asked the medical director of the trust whether he would close the hospital and cut all the services if it were not for the deficit problem that he had been told to sort out, he replied that the cuts were based not on clinical need but on financial problems. He will probably get the sack for admitting that, but at least he was honest, which is a damned sight more than Government Front Benchers' comments on the state of the health service today.
	I shall sit down in order to let many of my colleagues talk about the health service and its importance to them. However, I emphasise that decisions are being made today that affect my constituents' future. I think that we shall be among the first to be hit by the cuts. It appears that, by Easter, there will be no hospital in Hemel Hempstead. That is a disgrace.

Douglas Carswell: I never thought that I would say this, but it is a pity to see so few Labour Members of Parliament in the House. Across the vast expanse of green in front of me, I can count three and a half Labour MPs, which is about0.5 per cent. of the total composition of the House. It is a pity that so few Labour MPs have come for this debate on the vital topics of health and education, and that so many of them have chosen to take a long weekend, rather than coming to debate Parliament's legislative agenda for the year ahead. It is a pity that more Labour MPs are not here, because if they had come, they would have heard the excellent speech of their colleague, the hon. Member for Warrington, North (Helen Jones). She gave a thoughtful speech from which hon. Members in all parts of the House could learn a lot.
	I listened to the Queen's Speech with great interest and was delighted to hear that the Government plan a programme of educational reform. Indeed, there is much that needs to be changed. I was pleased to hear that the Government plan to reform further education. Again, there is much in need of reform. There is probably the need for a new Bill on further education, preferably one that gives further education institutions real autonomy to run their own affairs.
	I should like further education institutions to have the power to carry on running their own affairs and would welcome the idea of them awarding their own degrees. We need to ensure that they have even more independence from Government interference and the target-setters in Whitehall, regardless of which political party holds office. However, we need to ensure that any Bill does not swap higher education institutions' independence from Whitehall for dependence on remote and unaccountable quangos.
	The learning and skills councils are not fit to oversee our further education institutions. Self-government for further education institutions does not mean government by learning and skills councils. Further educations institutions need to be made accountable not to Whitehall or learning and skills councils, but to those who use them.
	I also fear that we will see a creeping agenda of regionalisation in the way learning and skills councils are organised. That will not make for more local accountability, but for corporate bogus accountability. If we put our further education institutions at the beck and call of unaccountable regional quangos, further education institutions will look back fondly to the days of Whitehall control. We need to set them free.
	In the Gracious Speech, the Government talk about the need to raise educational standards for all children, but I was disappointed not to see anything relating specifically to children with special educational needs. I have worked on the Select Committee on Education and Skills with Members on both sides of the House, including the hon. Member for Warrington, North. It recently produced a report that was highly critical of the existing policy on special needs education. In my constituency, Leas school in Clacton was shut as a result of the enforced inclusion policy. That closure meant that a lot of pupils who might otherwise have chosen to be in a special school were forced into mainstream schools. That policy, which has caused much hardship to parents in my constituency and to those in Clacton, is also causing hardship to children with special educational needs and their parents up and down the country. The work that we have done has helped to achieve a new consensus among parents, charities and the voluntary sector that the policy of enforced inclusion has gone too far. In the Westminster Hall debate we had on the subject the other day, pretty much everyone, apart from the Minister, agreed about that. Yet confusion remains about what is the Government's policy. Is there still a policy of enforced inclusion? Are the guidelines and the statutory guidance, as the Select Committee found, still pushing local education authorities towards a policy of inclusion? There is a need for clarity. The Queen's Speech is a missed opportunity to introduce legislation to clarify where the balance lies between inclusion and mainstream.
	The Queen's Speech shows, particularly on education but in other areas too, a general unresponsiveness on the part of the Government. I remember the somewhat heady days a few months ago when the Government announced a White Paper on education reform to set schools free. I supported the Prime Minister when he said that, every time he tried reform, he wished he had gone further. This Queen's Speech shows that, true to form, lightweight or heavyweight, he is still pulling his punches; he is not going far enough.
	Why was the Queen's Speech so unresponsive? I would like to make a broader observation about the way it is drafted and about the way this Parliament sets the legislative agenda. Clearly, the Queen's Speech is not written by the Queen, yet I suspect that elected MPs made no substantive input to it. At best it is the work of half a dozen Ministers—but work conducted at the direction of remote Whitehall officials, rather than at elected MPs.
	The Queen's Speech is not drafted by Her Majesty, nor was much of its authorship down to democratically elected Members of this Chamber. Much of the work is done by remote and unaccountable civil servants, technocrats and remote quangocrats. That is why it contains the perennial calls for things such as identity cards, and the perennial demands for new powers for this or that quango.
	This Queen's Speech is a Sir Humphrey's wish list. It outlines measures to be rubber-stamped by this supine House for the convenience of the quango state that really determines policy. Listening to the speech, I wondered how much longer we can continue to have our country's legislative agenda set by a tiny unaccountable Whitehall elite. How much longer should a tiny elite have a monopoly in setting our country's legislative agenda? I would like to see a Queen's Speech drafted not by the heads of various quangos, civil servants or technocrats, but with the direct input of the people. I believe that we need a right of popular initiative so that everyone in Britain can have a voice in the Queen's Speech.  [Interruption.] The Minister laughs, but there is a good case for direct democracy, and he might wish to listen to the voice of the people.
	As a mere Back Bencher, like most Members, I had zero-impact on the drafting of the Queen's Speech—as did most Ministers, I suspect—and therefore zero-impact in deciding this Parliament's legislative agenda. As a Member of Parliament, my best hope is to put my name in for the private Member's Bill lottery. If I were lucky enough to win it, I would introduce a Bill that allows for proper Queen's Speeches in the future: speeches that contain measures drafted by popular initiative and that reflect a system of government that is made of the people, by the people and for the people.

Daniel Kawczynski: My hon. Friend the Member for Harwich (Mr. Carswell) referred to this Chamber as being supine, and I agree: apparently, there is a lack of Labour Members who want to scrutinise what their own Government are doing, and it is a great regret that so few of them are present.
	I must start by expressing my anger at the Minister of State with responsibility for delivery and quality at the Department of Health, who is no longer in the Chamber. He scoffed and laughed at my hon. Friend the Member for South Cambridgeshire (Mr. Lansley), the shadow Secretary of State for Health, when he started to talk about Welsh patients. The Minister simply shouted across the Chamber that that was not his responsibility, but I have to inform the House that it is his responsibility. He is responsible for Welsh patients because almost all patients in mid-Wales come across the border to use the Royal Shrewsbury hospital, which is an English hospital. In fact, my hospital loses almost £3 million every year because the Welsh Assembly pays a far lower rate for its patients than English authorities do. Therefore, the Minister should be ashamed of himself.
	I decided to speak in the health debate because I recently carried out a survey of all of my constituents. One copy of that survey went out to every household, and we have so far received 8,000 replies. Apart from showing a very large swing from Labour to the Conservative party, and an even greater swing from the Liberal Democrats to me, they show that the top priority is the Royal Shrewsbury hospital. My constituents are extremely concerned about the£34 million of debt that it is currently in.
	The Secretary of State has said to me and the chief executive in private meetings, "Well, of course it is your problem, isn't it, because you have been overspending?" How on earth can a hospital such as the Royal Shrewsbury be blamed for overspending? Its managers are not spending that money on luxuries or on sending themselves on Caribbean cruises. They are spending the money on medicine and the other vital things that the hospital needs to provide for the people of Shropshire. One example of that is Herceptin; there has been a huge increase in demand for it, so there needs to be more funding. But the Government simply are not providing enough funding for hospitals.
	I shall now turn to maternity services, which I feel very passionately about because my first child was born just three weeks ago: a beautiful little baby girl. Mercifully, she looks like her mother; she is the spitting image of her mother—she is beautiful. Her name is Alexis.
	I wish to describe the level of service that we received at the Royal Shrewsbury hospital when we were waiting for little Alexis to be born. The midwives were superb; they were extremely hard-working, professional and comforting, and I am deeply indebted to them. They were also, however, extremely busy. The labour ward was full throughout the entire time that we were there. Many midwives came up to me late at night and said in hushed whispers, "We're going to have maternity beds cut. You can see how busy we are, Mr. Kawczynski, and that all the beds are occupied. We must tell you that four beds will be cut in November. Another four will be cut in December, and in January eight will be cut."
	So between now and January, 16 of the Royal Shrewsbury hospital's maternity beds will be cut. That is an absolute disgrace. That so many maternity beds can be cut in this socialist utopia in which we apparently live fills me with absolute horror. What upsets me is that—as is always the case with the NHS—these people come to talk to me in hushed whispers because they are absolutely petrified of losing their jobs. They do not want to go public because they work in a regime of fear, and they worry that, if they rock the boat, they could lose their jobs.
	The maternity beds are being cut because outside consultants, who want to reduce the £34 million-worth of debt, have identified that in Shropshire, on average, a woman stays in hospital for 2.6 days after giving birth. The figure for the United Kingdom as a whole is 1.6 days, so they have latched on to the fact that women in Shropshire stay in hospital for longer than is normal, compared with the rest of the country. That is why they want to cut beds—to get the women out quicker. However, that is totally wrong, because the help that the mother—and the father—get after the birth and while at hospital is absolutely invaluable and very necessary. They are taught how to bathe, feed and generally look after the baby; indeed, the help that they receive from the midwives is tremendous. Simply trying to get women out of hospital as quickly as possible will lead to far greater problems further down the line.
	Of course, it is much easier for us, because my parents-in-law have moved very close to us—on a temporary basis, I hasten to add. My mother-in-law is renting a house just two miles away, until Christmas, in order to help with the baby, and I am very grateful to her.

Charles Walker: We thought that it would be £350 million, but we now hear that it could be well below £300 million. That decision was taken without consultation or any warning. It was just announced at a meeting. That is giving us all cause for great concern. The Lister hospital has fantastic staff and they do an excellent job within the resources that they have, but the Lister hospital too is looking tired. There are problems with the infrastructure and structure there, so investment is needed.
	This type of electioneering, whether it is done by the Labour party or even the Conservative party, does bring politicians into disrepute. We really must not promise, for short-term political gain, things that we cannot deliver or have no intention of delivering.
	That brings me to the funding of the NHS. Only recently a gentleman in his early 50s, a police officer, came to my surgery. He has secondary bowel cancer. He, his wife and his family are desperate to get him a treatment made by the pharmaceutical company Merk, to help stem the spread of that cancer and perhaps give him a future. That drug is not provided on the NHS; one has to get it privately and it costs between £20,000 and £25,000. There are more of these drugs in the pipeline. I hope that the House will agree that this is a serious point: I am concerned that no matter how much goodwill there is in this Chamber for the future funding of the NHS, the NHS within its current structure and current confines will not be able to find the resources to provide those drugs. It is incumbent on the great brains on the Labour side of the House and the great, huge brains on the Opposition side of the House to provide this country with an NHS that can meet the demands of an increasingly sophisticated user group. And perhaps, in doing that, we need to have more cross-party discussions on the best way of providing these health services to all our constituents, regardless of which constituencies we represent.
	I have been speaking for seven minutes, which means that I am going to give hon. Members another six minutes of this, which will come as a grave disappointment to many but is of great delight to me.
	I am concerned, but also interested, to hear that there is to be a mental health Bill. I am interested to hear that because mental health is of huge importance to me and my constituents. We have an excellent mental health trust within Hertfordshire, which has seen its resources diminished over the past year. It had to make a £6 million saving last year and it will have to make a similar saving next year. I do understand that within the area of mental health there is an argument for reducing the number of hospital beds and transferring services into the community to destigmatise mental illness, but I am concerned that in our county,St. Julian's ward in St. Albans is being closed while at the same time we are reducing services in the community; so we are getting a lose/lose situation as opposed to a lose/win situation. I hope that the mental health Bill will reaffirm the Government's commitment to providing first class mental health services, because there is some concern in Broxbourne that they are being run down and that they will not be able to meet people's expectation.
	On the issue of mental health, like many Members, I have seen some tragic cases that I find very moving, particularly in the area of schizophrenia. There are families who are at their wits' end when a loved one—a child, a mother, a father, a son or a daughter—is suffering from that disease. When I look at my children, I think, if they are going to get an illness, please God do not let it be schizophrenia, because for many it is a life sentence. It is an illness that never leaves and, at best, can be controlled. For that reason, I hope that we can work collectively, as politicians, to destigmatise that awful illness.
	I missed some of the speech from my hon. Friend the Member for West Chelmsford (Mr. Burns), but in the 10 minutes that I caught he made some powerful points. Although, of course, we have an obligation to protect the public, the last thing that we want to do is lock up people with an illness, with no hope of getting out, meaning that they lose all hope of having a future. That would be a huge sadness to me and I could not countenance ever supporting it.

Nigel Evans: It might well be. I suspect that a lot of red meat will be thrown towards the Labour Benches over the coming months. We must look to see what is good in education and preserve and improve it. The last thing that we would want to do with the fine grammar schools that we have in this country is to junk them. What has happened in Northern Ireland is a complete disgrace, and I hope that the Secretary of State for Education and Skills will give us an assurance that grammar schools will be preserved.
	I shall move on to the health service. I am chairman of the Commonwealth Parliamentary Association's virtual HIV working group. As I am sure Ministers know, in the past 10 years, the incidence of HIV/AIDS has increased dramatically throughout the world, especially in Commonwealth countries, and in the United Kingdom within the past few years the incidences of HIV infection and AIDS have quadrupled. That has to be a cause of concern.
	The Secretary of State for Health told us that we were to have a £50 million advertising campaign on sexually transmitted diseases, but then nothing happened until just this week, when a £4 million television and radio campaign, which I believe has already started, was announced. That is chickenfeed compared with the £50 million that was to be spent. When sexually transmitted diseases are spreading as they are in this country, surely the right thing to do is to ensure that we have a good advertising campaign. Prevention is better than cure. I hope that the Government will carefully consider that. I understand that the £4 million campaign is hard hitting, which is the right approach if we are to get the message across, but let us consider how to make that message more effective. When the Government promise that they will spend £50 million—and get a headline for doing so—but then do nothing and only belatedly spend£4 million, that is not good enough.

Angela Watkinson: I am grateful for the opportunity to contribute to the Queen's Speech debate on health and education—but I am rather surprised by the array of empty Benches on the Government side of the Chamber. Whatever happened to "schools and hospitals"? Whatever happened to "education, education, education"? Perhaps the Government think that they have resolved all the problems and there is nothing further to discuss, and that is why Labour Members are not present today.
	I want to speak about the further education Bill, which was mentioned in the Queen's Speech, the new measures to strengthen the probation service, and antisocial behaviour orders. I want to speak up for young people today.
	Young people get a bad press; only a small proportion get into trouble, especially through antisocial behaviour, but people tend to think that that is true of all young people. That is far from the truth—it applies to only a small number. However, the complaints against those who cause trouble are justified so I shall begin with negative comments, because I want to work up to a much brighter and more optimistic ending to my speech, when I shall concentrate on the good young people.
	The Mayor of London has provided free bus travel for young people. I am sure that that was well intended so that they could get and from college. Indeed, I am sure that many use it for that purpose. However, a significant number use it to cause mischief. They get on and off buses, behaving antisocially and causing nuisance. When on the buses, they intimidate not only passengers but the drivers. The police have a difficult job trying to catch up with them because they keep moving on. That sort of behaviour from a small proportion of the young people who use buses gives them all a bad name. It is a difficult problem to tackle.
	We must remember that hanging about in a group in public places is not an offence, but many people are intimidated simply by the sight of young people hanging about on street corners and in other places. However, they sometimes commit offences through nuisance, graffiti, damage to property and intimidation. Those young people get into the papers and other media and give young people generally a bad name.
	I note that antisocial behaviour orders will be strengthened. I do not know the details of that proposal, but getting an ASBO in place currently takes a long time—many police hours and a great deal of a local council's time. Gathering evidence to justify an ASBO is a particular problem because the victims of the antisocial behaviour are reluctant to provide it, for fear of recrimination. We therefore need to find ways of encouraging people who are on the receiving end of antisocial behaviour to give evidence so that the police or the local authority—or both if they are working in partnership—can obtain ASBOs more quickly.
	We also need to ensure that ASBOs have teeth. Some streetwise young people are not concerned when they get an ASBO; indeed, they are proud of it. We therefore need to break the circle of not caring about the approbation of society. Young people must understand that bad behaviour has consequences.
	There are also proposals to strengthen the probation service; again, I am not sure about the detail. I understand that they will tackle the way in which the probation service is managed and that its powers will be strengthened. It is important that whatever is done is effective and that probation officers are skilfully trained. They deal with difficult young people and need to co-operate with schools and the police in partnership so that those young people do not slip through the net, but turn their behaviour round and build a positive future for themselves.
	I hear anecdotally from my borough commander that young children are out unsupervised in public places late at night in the dark. His officers have taken home a nine-year-old with a four-year-old brother, and the parents were surprised to find a policeman on the doorstep with their children. They did not understand why they should be brought home, because they thought that they were all right. Those children do not have the benefit of parents who supervise and devote their time to them, and a good standard of behaviour is not set at home. That makes it all the more difficult for schools, probation officers and the police to try to get the children to understand what constitutes acceptable behaviour so that they have a good future.
	Many children who hang about on the streets claim that there is nothing to do. Well, in my borough there is lots for children to do, and I am sure that there is nothing unusual about that. There are the Churches, uniformed organisations, school clubs, sport, drama, art and music. However, some children are what we could call "unclubbable". It is not that there is nothing for them to join, but that they do not want to join. We have to make an enormous effort to turn those children round. Happily, they are not representative of young people as a whole.
	The good news is—I can speak for the young people in Upminster, but I suspect that there is nothing unusual in that, and that hon. Members throughout the House will be able to provide similar examples from their own constituencies—that there is so much going on for so many young people who are doing the right thing. Many young people are doing their best at school and behave acceptably, thinking of others and enjoying very happy lives, fulfilled with a whole range of activities, many of which are associated with our schools. Schools in the London borough of Havering are particularly good. We have a flagship service, which is one of the reasons why property prices are so high, with people moving in so that their children can attend Upminster schools—and it is such a good place to live that they do not move away again afterwards.
	Early years education is particularly important; we have a very good Sure Start children's centre in Harold Hill. If we can get very young children involved in that sort of thing before they enter formal education, they can learn social and interpersonal skills, how to accept one another, how to accept authority and how to conform. They can learn through play how to get on with one another so that by the time they go to school, they are self-confident, well adjusted and ready for teaching and learning. Half the battle is already won.
	Most of my local schools have school councils, and I have been impressed when visiting my schools—even including primary schools—at the standard of debate and questioning. I get some very probing questions from very young children, who often want to know first how much I earn, and then all sorts of other questions follow about what Parliament does, how to become an MP and so forth. They probably know more than many adults in the community about what the council does, what Parliament does and how laws are made. I was very impressed. They also have their own anti-bullying policy, and debate problems in school. I have observed school councils in operation: the meeting skills are excellent, with one person speaking and everyone else listening. It helps to build up the next generation in a positive way.
	I happen to be a governor of two local schools, which have excellent standards of behaviour. Pupils move about the school unsupervised and in a sensible way. We can see that they are well adjusted, that they are enjoying their education and that they behave perfectly. One of the schools is a Roman Catholic girls secondary school, where the pupils gain the benefit of having an ethos in school that is the same as the ethos that they experience at home. That is an amazing advantage and there is a high level of parental interest in what goes on in the school. That support, and the link between what goes on at school and what goes on at home, enables those pupils to fulfil their full potential academically, not to mention all the other skills that schools have to offer. I am very pleased that the Government will, because of the overwhelming wish of the public and hon. Members on both sides of the House, support faith schools, which are hugely successful.
	I have been particularly impressed by the drama, sport and music going on in our schools. Hill Mead school, for example, puts on a musical every year and the standard is absolutely amazing. There is standing room only because every year the annual musical is so good that the news goes all around. We think that it will not be possible to better the performance next year, because this year's must be the peak. Yet every year somehow it gets even better. As well as acting, singing and dancing, students are learning choreography, stage management, lighting, prop making and so forth. Many students in the school are involved in the production and it is enormously successful, providing those involved with huge self-confidence in their achievements.
	The head teacher told me about one occasion on which he took a coach load of pupils up to see a west end production of a show that they were going to put on. He said to the pupils afterwards, "I hope that you'll be able to do it almost as well as that," to which they all replied, "No sir, we're going to do it better." Those are children who are becoming confident about what they can achieve in life.
	A group of children from the same school have just been to Kenya under the Kids Alive scheme, where they mixed with children who live in deprived and modest circumstances. The exchange between those two groups of children was enormously beneficial, with each group learning a lot from the other.
	There are lots of wonderful things going on in our schools. It is the majority of our young people who are achieving and who think of others as well as themselves; it is the few who give all young people a bad reputation. Those are the ones who get things wrong and catch the attention of the press and the media.
	We also have the wonderful Saturday music school in Havering. The musical achievements of the students who go there and the virtuoso performances that we hear at their concerts are very impressive. I wish that every child could have the opportunity to learn an instrument, because once they learn one, they often learn several others. The skill helps them in maths and other lessons, and is hugely beneficial to them throughout their entire lives. The ability to entertain and please others while doing something that one enjoys oneself is a wonderful skill to have.
	I should like to draw the Secretary of State's attention to a wonderful project at Havering college of further and higher education, which was started by two lecturers who have children with learning difficulties. Those lecturers run a life skills course for children with learning difficulties called ROSE, which stands for realistic opportunities for supported employment. Those students are assigned a job tutor who finds local jobs for them, with huge support from local employers, through their corporate responsibility. The job tutor will take the student to work from their home, stay all day to settle them in and ensure that the other employees are happy and understand them, and then take them home again. The support that the job tutors give is gradually withdrawn inch by inch, so that at the end of, say, a six-month period, the student with learning difficulties is independent and working. That spares those people from a lifetime of benefit dependency and inactivity. I should like that example of good practice to be copied throughout the country.
	I am an ambassador for guiding, and on Remembrance day I always give the local scout troops the beaver, cub and scout awards for the year. All those youth organisations depend heavily on volunteers, and last Sunday there were three new volunteers. I asked the troop leader, "How on earth did you find three new volunteers?" because we all know how difficult it is to persuade people to give their time to youth organisations, as their own lives are so busy. The answer was, "These were three parents who wanted their own boys to join." They were told that unless they became volunteers, their boys would not be able to join, because the troop would not be able to run. We need to find ways to encourage more people to help in youth organisations. Our local boys brigade band led the Royal British Legion to the church for the Remembrance day service last Sunday. That is the sort of good thing that young people are doing up and down the country; it is an example from Upminster, but I am sure that all hon. Members can give similar examples.
	There is a wonderful youth parliament in the Robert Beard youth club, which takes a particular interest in how Parliament is working and gives me a thorough grilling about what is happening. The young people there are the MPs for the future. They have concerns for the environment and the community, and are responsible and positive-thinking young people. They could not be more different from the young people we keep hearing about who get in trouble and grab all the publicity.
	I finish with a brief anecdote. My grandchildren do a range of activities. The youngest one is a competent skier, he can swim, he plays football, he does judo and he does bell ringing. He is now able to ring bells at weddings, so he has reached a certain level of competence. However, his PE teacher wrote in his end-of-term report that he was unco-ordinated. My daughter was in high dudgeon about that. She said, "How can he possibly be unco-ordinated if he can do all those things?" On reflection, however, we thought that the lack of co-ordination probably came between the teacher's mouth and Billy's ear. He obviously was not paying attention to what he had been told to do. They cannot be perfect all the time, can they? Let us remember that the vast majority of young people are really good, and not let our opinions be swayed by the few who get it wrong.

David Willetts: We have had a wide-ranging debate with some interesting and distinguished speakers. Thinking back to old times, it was a pleasure to hear from the hon. Member for Northavon (Steve Webb), whom I think of as an expert on the finer details of the benefits system. I did not know that he was such an expert on sperm donation as well. I realise now how wide ranging his experience is.
	There was a passionate speech from my hon. Friend the Member for West Chelmsford (Mr. Burns) on mental health, although I thought my hon. Friend the Member for Bosworth (David Tredinnick), who is well known for his support for complementary and alternative medicine, perhaps went a bit far when he said that it was possible to remove someone's head under acupuncture. However, we understand the broad point that he was making.
	We had a range of distinguished speakers on the Conservative Benches: my hon. Friends the Members for Sevenoaks (Mr. Fallon), for West Chelmsford, for Bosworth, for Hemel Hempstead (Mike Penning), for Harwich (Mr. Carswell), for Shrewsbury and Atcham (Daniel Kawczynski), for Broxbourne (Mr. Walker), for Ribble Valley (Mr. Evans) and for Upminster (Angela Watkinson). That list shows that we had both the quality and the quantity on this side of the House.
	There were nine speeches from Conservative Back Benchers in this debate on health and education—nine of, sadly, still only around 200 Conservative Members—so 5 per cent. of Conservative Members contributed. We had speeches from four of the 350 Government Back Benchers, so just over 1 per cent. of their Back-Bench Members spoke. We do not yet have the independent statistics commission, but I take that as meaning that five times more Conservative Back Benchers spoke. We can conclude from that that Conservative Members are five times more committed to health and education than Labour Members.
	The hon. Member for Amber Valley (Judy Mallaber), who is not in her seat, spoke about the Congolese rain forest, but we rightly focused on health and education. The Secretary of State for Health is back in her seat. We found it extraordinary that she maintained that there was no connection between the financial crisis clearly facing the NHS at the moment and the way in which payment by results has been implemented. She maintained that that was an extraordinary coincidence, but Conservative Members understand that those two events are directly connected, as my hon. Friend the Member for South Cambridgeshire (Mr. Lansley) powerfully argued. It is the way in which payment by results has been implemented—not the principle—that is such an important reason for the financial crisis that has been described by so many of my hon. Friends today.
	I see that in my part of the country on the south coast. In Havant and Portsmouth, threats of closure face Haslar hospital, Havant war memorial hospital, Victoria cottage hospital in Emsworth, andSt. Richard's hospital in Chichester. The Government say, "Do not worry, all the money is going into the rebuilding of the Queen Alexandra hospital in Portsmouth." The trouble is that the patients, GPs and other doctors prefer the smaller, local hospitals, over which the threats are hanging—some of them have already had to close. It is no good Ministers deploying the rhetoric of how much they value community hospitals when, as we have heard today by mention of so many real-life examples, local community hospitals are most under threat from the financial crisis facing the health service.
	As we have the good fortune of having both the Secretary of State for Health and the Secretary of State for Education and Skills present on the Front Bench at the same time, I should like to ask them about something that combines health and education, but which has not been referred to in the debate: the financial crisis facing some universities as a result of the failure by the NHS to meet its commitments on budgets for training the NHS workers of the future.
	The CMU—Coalition of Modern Universities—group says that the question marks over NHS contracts represent one of the biggest present causes of instability for modern universities, which have had their own strategies to meet demand based on previous assurances about contract requirements and prices. The group goes on to say that those universities obviously have staff and training facilities in place to meet staff-student ratios and the other requirements as required by the professional bodies which accredit the courses.
	Therefore, I wish to ask the following questions of the two Secretaries of State. Will the Secretary of State for Education and Skills confirm that he recognises the financial pressures that are on some universities as a result of NHS cuts in the training of nurses, doctors and NHS workers for the future? Will the Secretary of State for Health recognise that taking NHS training through a boom-bust cycle, and driving universities into deficit and causing them to close some of those training facilities, is no way to ensure that we have the trained doctors and nurses whom we need in future? In fact, it would be a source of great comfort to us if we knew that the two of them have even communicated about that important issue which is shared between health and education.
	In the Blairite spirit that makes initiatives sound like something from the Chinese calendar, the Secretary of State for Education and Skills has said that this year is to be the year of skills. We welcome a debate on the importance of skills and training, but before turning to skills, I wish to ask the Secretary of State about some of the loose ends from the Government's education legislation, because it is important that they live up to some of the commitments that they have made.
	An undertaking was made in the other place that there will be an investigation into making it possible for kids in state schools to sit exams such as the IGCSE—the international general certificate of secondary education. The Government have talked a lot about raising standards in state schools so that they match independent schools. One basic way in which we could show that we are committed to that principle would be by making it possible for students in state schools to sit the same exams as are now available to students in independent schools. It is wrong that we have two nations in education, with exams for which pupils at independent schools can study but for which those attending state schools are not permitted to do so. I hope that we will hear from the Secretary of State what the time scale is for the consultation that was promised on that subject in another place.
	I also hope that the Secretary of State for Education and Skills will tell us a little about the Government's commitments on academies. I was struck by the following recent newspaper headline—from  The Daily Telegraph, I think: "Blair pushes for more city academies to seal legacy". Apparently, the Prime Minister was a bit worried about his legacy and was very keen to get as many academies as possible in place before he left office. Let me assure the Secretary of State that the Prime Minister need have no worries about his academy legacy. Conservative Members believe in academies, and we will support them; there is no danger to academies, or the expansion of them, from us.
	I wonder whether No. 10's anxiety about the legacy was because of someone rather closer to home, whom they thought might be the real threat when the Prime Minister leaves office. I am sure that the Secretary of State will welcome our suggestion that the best way of guaranteeing the future expansion of academies is to have a smooth and orderly transition from the Prime Minister to my right hon. Friend the Leader of the Opposition, who will ensure that the academy movement carries on and extends.
	We have also had statements recently from the Secretary of State about 16 to 18-year-olds. He is reported to have said that he expects them to stay on in education or to go into training. It will be very interesting to hear from him exactly what he meant by that. Within 48 hours of his making that statement, the Chancellor of the Exchequer made it clear that in his view nobody is suggesting that children who do not want to do so should stay on at school full-time until 18. So exactly what kite was the Secretary of State flying? Will he explain what his commitment was?  [Interruption.] Labour Members say, "It's not about schools", but if it is about training, what form will it take?
	Will the Secretary of State also confirm one of the most scandalous statistics of this Government's time in office? When we left office in 1997, there were 157,000 16 to 18-year-olds not in education, employment or training—the so-called NEETs: the people whom the education and training system has let down. That figure that was already far too high. Will the Secretary of State confirm that according to the latest figures there are now 220,000 such people? Despite all the Government's efforts, there has been a 40 per cent. increase in the number of 16 to 18-year-olds who are not getting started in the basics of further education or training. So of course we need some initiatives on that. What do the Government propose to do about it?
	We Conservatives know what needs to be done. We understand that those young people have become detached from education. They have lost contact with, and faith in, training because, sadly, many of them have been let down by an education system that has not provided them with the basics. Almost half of all 11-year-olds still leave primary school unable to read, write and add up. What they need is synthetic phonics—an issue so powerfully pressed by my hon. Friend the Member for Bognor Regis and Littlehampton (Mr. Gibb)—as the basis of reading, so that they can remain engaged with and attached to what is happening in the classroom. Far too many classes are still not put into sets, yet setting often enables teenagers to learn and to participate in lessons that are conducted at a speed that is right for them.
	We are told in the Queen's Speech that we will have a Bill on further education. I hope that the Secretary of State will take us through it and explain today some of what he is doing. This is of course very odd. Although we have been told about that Bill, we have yet to receive the Leitch report that was commissioned by the Chancellor of the Exchequer—it is due to be published around the time of the autumn statement—which is supposed to set out the Government's skills and training agenda. The Department for Education and Skills has announced a Bill, which is presumably in the process of being drafted, before we have had the Treasury's proposals, which will be introduced next month. That seems an extremely odd way to run a Government.  [Interruption.] We are indeed waiting for Gordon.
	I must tell the Secretary of State that if I were to describe the slow process whereby a Government decay and lose momentum, it would be when the best that they come up with on a subject as important as education is a set of proposals to reorganise their previous reorganisation. We have now reached the stage where the "radical" new measures in the further education Bill will involve changing a structure that the Government themselves introduced within only the past few years. It is at the point when one is reorganising one's own reorganisation that people lose confidence.
	In fact, the Secretary of State should take some advice from the Secretary of State for Health. If there is one reason why the NHS has got into such a mess, it is the nine reorganisations to which it has been subject. Yet what does the right hon. Gentleman propose for education? He proposes a further reorganisation. He is apparently going to get rid of local learning and skills councils—and replace them with regional learning and skills councils. However, it was only in 2000 that his predecessor, the right hon. Member for Sheffield, Brightside (Mr. Blunkett), introduced the legislation that created the local structure. He told the House on Second Reading of that Bill:
	"There will be co-ordinated planning, funding and delivery of flexible services at local level, with sufficient responsiveness and delegated power to sub-regional learning and skills councils to enable them to respond to the needs of their travel-to-work and travel-to-learn areas."—[ Official Report, 30 March 2000;Vol. 347, c. 523.]
	Why have the Government changed their mind?
	We in the Opposition have our disagreements with the learning and skills councils. They cost a lot of money, not enough of which gets through to FE colleges and trainers. However, we know that this country is localist rather than regionalist. My hon. Friend the Member for Harwich (Mr. Carswell) is an eloquent exponent of that belief. Given a choice as to where decisions on such matters should be taken, I should have more confidence in those taken at local level.
	In his report of only a year ago, Sir Andrew Foster proposed a strengthening of the role of local learning and skills councils. He said:
	"Local learning and skills councils need to be the pivotal centre of the local community's interest, working collaboratively with local authorities, in their new local commissioner role".
	The report wanted to enhance the role of local skills councils, so why is the Secretary of State going to abolish them and shift power to the regional level? That does not seem to be the right way forward.
	Another proposal in the Bill will apparently be a power to remove college principals. The lack of principle is a sort of summary of this Government. They will remove the principals, yet they claim that that will be a liberalising, decentralising measure. However, we all know that the result will be an increase in central influence and power.
	I hope that the House will forgive me for being a little cynical, but when I hear that FE colleges are to get a power to grant degrees I wonder whether anything in the real world will change or whether the proposal is merely a device to enable the Government to reach their target of 50 per cent. of students receiving a higher education or university degree. The Government will not reach the target by doing anything that improves the opportunities available to young people, but merely by redefining some of the qualifications that they already receive. Will the Secretary of State say what the provision will mean in the real world, or is it simply a device for achieving the Government's target?
	One other question arises in connection with the further education Bill. The briefing note provided by the Department states that it will also contain provisions to "modernise and streamline" the way in which industrial training boards "demonstrate consensus" for their levy proposals by amending the industrial training legislation. I am not absolutely sure what that means, but I suspect that the intention might just be to make it easier for training boards to impose levies on local companies.
	Will the Secretary of State assure the House that the provision will not make it easier to impose levies without a genuinely voluntary arrangement? That would simply be another cost on business at a time when, as the Secretary of State knows, the evidence is that employers rarely use official training providers for the training that they need.
	Opposition Members believe that the proposals in this Queen's Speech on health and education are evidence of a Government running out of steam and ideas. They have lost contact with the real crisis facing the NHS described by my hon. Friend the Member for South Cambridgeshire. They have not been able to deliver their new deal promises to improve employment and training opportunities for our teenagers, and have resorted to endless reorganisation instead of tackling the real problems facing our country.

Alan Johnson: This has not been the best attended debate but it has been one of the most fascinating that I have attended— [Interruption.] I accept that there were fewer Labour Members but there were three times more women Members on the Labour Benches. The debate has been genuinely fascinating, with some excellent contributions.
	I understand very well the Opposition's problem. Their stewardship of these two most important public services—health and education—was so appalling during their 18 years in government that they need to do two things. I can see their strategy clearly. First, they have to assure the public that our vast increases in investment, which they cannot deny, will be safe under their stewardship. Secondly, they have to convince public servants that there will be warmth, sunshine and love in their lives if a Conservative Government ever return to power.
	The hon. Member for South Cambridgeshire (Mr. Lansley) struggles with those two issues. As  Hansard will, I hope, record tomorrow, he said at one stage that the NHS has improved, yet in his peroration he said that the NHS will not improve under the Labour Government, which is a contradiction. Although he had already announced that there would be 20,000 job cuts in the NHS, he said that that would not happen and he accepted that it was only what someone had told him and that it might not be the reality, which is another contradiction.
	I learned from my right hon. Friend the Secretary of State for Health about the hon. Gentleman's fascinating policy on the burden of disease—a new way of funding the national health service, which will take £70 per constituent from South Cambridgeshire and give it to Labour constituencies. We have also donethe calculations for the hon. Member for Hemel Hempstead (Mike Penning), who is just returning to his place. He is concerned about his local health service, of which he is a prominent champion. He would lose£174 per constituent. The contradictory strategy of trying to demonstrate that the money is safe in Tory hands while insisting that despite all the extra money there has been no improvement is doomed to failure.
	The hon. Member for South Cambridgeshire said that the Opposition would not support the mental health Bill. I urge him to listen to the—

Alan Johnson: Eighty-five thousand more nurses and 32,000 more doctors are certainly not managers.
	Can the Opposition convince the public that they would maintain that kind of investment? I doubt it, given their third fiscal rule, which will oblige them to share the proceeds of growth between public investment and tax cuts. I also doubt it given the document in the name of the shadow Chancellor that suggests that there will be £21 billion-worth of tax cuts under his party. We ask ourselves, will members of his party be any less hostile to public sector workers if they return to government?
	Under their previous regime the Conservatives declared war on lone parents, which the hon. Member for Havant was the first person to say would now cease—they have apparently buried the weapons on that. They also declared war on public sector workers. Last week, when public sector workers were lobbying the House, I wonder how many of them were told about the Conservative party's plans to tear apart, break up and disengage from the agreement that we have reached to protect the pensions of civil servants, nurses and teachers—that statement was very clearly made by the shadow Chancellor. I do not believe that anything has changed among those on the Opposition Benches.
	The hon. Member for South Cambridgeshire finished his speech with the comment that there was nothing in the Gracious Speech about education. That, along with the suggestion by the hon. Member for Birmingham, Yardley (John Hemming) that we were the Department for Education and Science, suggests that skills need to be reinforced across the Benches of the two main Opposition parties, so that Members wake up to the importance of further education.
	I listened to a number of really good contributions today, but none was better than the speech by my hon. Friend the Member for Warrington, North (Helen Jones). May I add to the congratulations? It was one of the most thoughtful, incisive speeches that I have heard in the House. First, she spoke about the need to look at adults in terms of our whole education and skills programme. I shall come to Lord Leitch's report in a second, but he produced an interim report back in the summer in which he pointed out that 70 per cent. of the work force of 2020 are already out in the work force now. He also pointed out that we are not world class on skills and we need to do much more, and that is true.
	The speech by my hon. Friend the Member for Warrington, North was so powerful because she talked about instilling the value of education. She mentioned the role of the trade union movement, historically an important role dating back to miners' libraries, but now reinvented in the form of union learning reps. My hon. Friend's speech added to my understanding of how far we have come in the past 50 years. We have to remember that higher education—which I shall also mention in a second, given that I have had the invitation to do so from the hon. Member for Havant—was the preserve of a tiny elite 60 years ago; indeed, at the time Opposition Members fought tooth and nail to keep it that way. When A-levels were introduced in 1951 they were for the 7 per cent. of youngsters who would go on to university. So my hon. Friend's point about the culture of learning, and matching the building of aspiration to making places available to young people to meet those aspirations, was extremely important and moving.
	The importance of further education is, as my hon. Friend also said, an issue of social progress—I certainly repeat that every time that I talk about the importance of skills and education—but there is also an economic argument for skills and investment in FE that is more profound now than ever before. By 2014, two thirds of jobs will need to be filled by those with at least intermediate-level skills. By 2020, 40 per cent. of jobs will need to be filled by graduates. Today, the analysis shows that there are 9 million skilled jobs, but by 2020 we shall need 14 million skilled jobs. Today there are 3.4 million unskilled jobs; by 2020, we shall need only 600,000. That is an enormous challenge for our society.
	When we were pushing through the Higher Education Bill in the face of stern and fierce opposition from the Opposition, the position of the Liberal Democrats, which I understood, was that we needed the funding but we should get it through an increase in tax, but the position of the Conservative party was that we needed plumbers, not graduates. It was that we needed to shrink the levels of participation —[ Interruption. ] Yes, it was. Conservative Members shake their heads, but I can read the relevant parts of  Hansard to them. The Conservatives claimed that the way to tackle the problem was to shrink higher education, so that instead of expanding to 50 per cent., we would reduce participation to 36 per cent.
	I agree that there were then two further shifts before we got to the current policy. In April 2005, the current Leader of the Opposition said that the Conservatives were saying that fees should be scrapped. The hon. Member for Havant said that the Conservatives did not support the Government's target for expansion and, as fees are necessary to finance the expansion target, if we did not have the expansion target, we did not need the fees. That policy was described by the hon. Member for Banbury (Tony Baldry) as coming from the planet Zog.
	When the hon. Member for Havant talks to me about higher education, let me remind him that, under his Government, higher education funding fell by 36 per cent. between 1989 and 1997. The Dearing committee was set up by the Conservative party on the basis that Dearing must, under the instructions of the then Chancellor, find a further reduction of 6 per cent. in real terms. Dearing reported that the most that the higher education sector could stand was 1 per cent. However, we get comments about the threat to universities and the problems with medical students. The threat to universities came from the Conservative party and it was the courage on the Labour Benches that ensured that we generated not just £2 billion from tuition fees, but an extra £2.6 billion from the taxpayer.
	The investments in higher education have been extraordinary, as have the investments in further education. In those 18 bleak years of Tory stewardship, further education funding went down by 14 per cent. in real terms. We have now increased funding by 48 per cent.
	Members on both Opposition Front Benches have asked an important question. The Leitch review is imminent. What we believe, coming on from Foster, to the White Paper, to the Bill, is that the further education infrastructure needs to be in place to meet the challenges that we know from the interim report that Leitch is going to raise. We do not see a need to wait for Leitch before the Bill. Indeed, we think that Leitch's report will make such radical proposals that there will need to be a further period of consultation. I doubt very much whether there is anything in Leitch that will necessitate our changing the Bill, to answer the question raised by the hon. Member for Brent, East (Sarah Teather). However, unless we have the infrastructure in place in our FE colleges and our skills sector, we will not be able to cope with the kind of issues that Leitch will draw attention to.
	I was asked by the hon. Member for Havant about the situation with 16 to 18-year-olds. The statement that I made and the statement that the Chancellor of the Exchequer made were absolutely consistent. The argument is this: we need to find ways to inspire youngsters to stay on in education or training. We have expanded apprenticeships. There were only 75,000 when we came into government; now there are 260,000. We have reduced the drop-out rate at age 16 and 17 by introducing the education maintenance allowance and by other methods. As people found in Ontario and in the Netherlands, and as they do already in Germany and Belgium, when all those systems are in place we need to send a clear message to our youngsters—not an ambiguous message—that they should not be in employment unless there is some kind of skills training attached. All of the problems that we face, in relation to demography and globalisation, suggest that, at some stage, we will have to grasp that nettle. We need to look at that idea. Before we went down that route, we would need to have the widest consultation. However, I do not think that that is inconsistent with what we are trying to do in relation to FE and skills.
	The further education Bill and the two Bills from the Department of Health are necessary and important. Incidentally, I think that the education profession will be pleased to know that there will be only one education Bill on the statute book this year. For the reasons that my hon. Friends and I have set out, we should commend the Gracious Speech to the House.
	Debate adjourned.— [Huw Irranca-Davies.]
	 Debate to be resumed on Monday 20 November.

Mr. Deputy Speaker: With the leave of the House, I will put motions 9 to 12 together.
	 Ordered,
	That Private Members' Bills shall have precedence over Government business on 19th and 26th January; 2nd and23rd February; 2nd, 9th and 23rd March; 20th and 27th April; 18th May; 15th and 29th June and 19th October 2007.
	 Ordered,
	That, in respect of the Northern Ireland (St Andrews Agreement) Bill, notices of Amendments, new Clauses and new Schedules to be moved in Committee may be accepted by the Clerks at the Table before the Bill has been read a second time.— [Huw Irranca-Davies.]

Graham Stuart: I am pleased to be able to bring to the attention of the House the subject of sexual and mental heath services in the East Riding of Yorkshire. As hon. Members will be aware, the services are Cinderella services that are too easily ignored in the national health service. They do not carry the political clout of other matters. The Minister will be aware of my work on fighting for community hospitals, which has been backed by many hon. Members. When compared with the situation for sexual and mental health services, it is easier to organise public support for, and demonstrations on, institutions such as community hospitals so that local and national authorities can be persuaded of the need for change. Unfortunately, sexual and mental health services are easier targets for cuts.
	On a business-as-usual basis, the new primary care trust for the East Riding of Yorkshire would have been heading for a £20 million deficit this year. A turnaround team had to go in to effect changes. Before that team arrived, Ministers were wont to tell us that any overspending or deficits were due to poor local financial management. When cuts took place, their typical response was, "It's nothing to do with me, guv." However, as the Minister will be aware, the accountants who came in to East Riding of Yorkshire PCT—or Yorkshire Wolds and Coast PCT, as it was—found that there had been no financial mismanagement. They found that the PCT had done a good job in trying to steward its resources, but that a combination of centralised targets and the funding that came with them put the PCT in the position in which it found itself.
	As our ably managed primary care trust has tried to tackle its existing deficits, it has found—again, thanks to invention by central Government—that £8 million has been top-sliced and removed from the local area. That has had a further impact on the organisation's financial balance. The situation might become worse in the future because funding often seems to be gerrymandered to Labour areas and taken away from Conservative areas. Given the meetings attended by the chairman of the Labour party involving the famous heat maps, we know that health funding is too often used to address political needs, rather than health needs. The most deprived people in the community that I represent are the ones who pay the price of that twisting away from recognition of real health needs.
	Mental health services in the East Riding of Yorkshire are the 13th lowest funded in the country. The mental health trust is a three-star trust that does an excellent job with the resources that it receives, but there has been an historical failure of service provision because of the way in which the trust is funded. That position was worsened further this year by an additional £700,000 cut imposed on mental health services by the PCT because of its financial difficulties.
	As the Minister may know, a few days ago  The Independent reported that
	"Patients in Yorkshire have to wait longer than anywhere else in the country for cognitive behaviour therapy, a treatment proven to help relieve low-level depression and anxiety. For example, Wakefield West PCT has a waiting list of 78 weeks and in East Yorkshire people with mental health problems are faced with a wait of up to 52 weeks."
	That is not acceptable. The work of Lord Layard, whose report helped to bring the need for counselling therapies to the Government's attention, is being ignored, and people in my area are unable to access the services they need. Dr Foster, the health care information company, has conducted a survey of mental health charities and reports that cash-strapped trusts are diverting funds away from mental health services, and are instead using the money to plug gaps in other services. That story is heard all too frequently.
	That brings me to sexual health services in my area. As the Minister will know, the Department for Health announced that £315 million would be allocated to improve sexual health services across the country. All too often, however, that money has not reached the providers of sexual health services. Because of the financial mismanagement occurring throughout Labour's NHS, the money is being diverted away from sexual health services.
	The impact of that is strongly felt, and it is worth acquainting the House and the Minister with the statistics on sexually transmitted infections in Yorkshire and the Humber region. Between 1996 and 2005, there was a 216 per cent. increase in cases of genital chlamydia. Chlamydia is easily cured, but if it is not found by screening, it can lead to infertility and additional expense later, and it creates great misery for those affected. The figures also show an increase of128 per cent. in cases of gonorrhoea between 1996 and 2005. The incidence of syphilis has increased by1,650 per cent., albeit from a low base: the number of cases increased from 6 in 1996 to 105 in 2005. To continue the sad recitation, the number of cases of genital herpes has increased from 457 in 1996 to 556 in 2005—a 22 per cent. increase in incidence—and there has been a 28 per cent. increase in the incidence of genital warts in the same period. We have a serious and growing problem of sexually transmitted infections in our local area, yet moneys that the Government have put aside to tackle that problem are failing to reach the front line, despite assurances from Ministers that they would try to ensure that that did not happen.
	No doubt the Minister will mention the announcement in the past few days of a new sexual health campaign. That campaign is to be welcomed—indeed, Nick Partridge, chief executive of the Terrence Higgins Trust, did welcome it as a belated effort to raise the profile of such issues. Following that announcement, he said that, of the £315 million,
	"£50 million...was for new information campaigns, safer sex campaigns, condom promotion campaigns for young people, for all of those at risk of sexually transmitted infections."
	He went on to say:
	"Sadly, only a small part of that £250 million has been spent by local health managers by improving sexual health services, and so far only £3.6 million of that £50 million has been spent on promotion campaigns."
	The Government have failed to deliver the money to the front-line treatment services, and they have failed to launch the promised full-scale campaign to tackle this strong, growing local problem.
	Local services are currently being reconfigured, and between January and April next year, six sexual health clinics will close across the East Riding of Yorkshire, so that new, integrated clinics can be created. In its meeting of 12 September, East Riding of Yorkshire council's overview and scrutiny committee expressed concern about the large distances that many service users would have to travel to integrated clinics. It recognised that some services would be provided in GP surgeries, but said that
	"many people may not feel comfortable accessing those services from their GPs and may prefer the anonymity of obtaining service elsewhere. The Committee was also concerned about how the Trust would work with GPs to require them to provide enhanced services as part of their contract."
	As the Minister will be aware, when the GP contract was negotiated, sexual health services were given too low a priority under the points system that rewards GPs, so there is no incentive for them to take a continuing interest in this growing problem, which is a cause of real local concern.
	The local primary care trust prepared a report for the board meeting of 28 September this year. Under the heading of finance, there is a short statement that goes to the heart of the failure to increase local sexual health services. It says that the proposals to reconfigure family planning clinics will result in £51,000 in part-year savings in 2006-07, and that £102,000 will be the full-year effect. Rates of sexually transmitted infections are exploding in the area, but the amount being spent by the local primary care trust is being cut, despite Government promises to the contrary. The Minister may hope that, when the director of public health spoke at that board meeting on 28 September, he suggested some reason why the services were not needed, but in fact, he said:
	"If we were having a service based on need, and certainly on choice, the service would have to be considerably more extensive".
	The board concurred with that conclusion, but because of the Government's financial mismanagement of the NHS, services are being cut, instead of increased.
	One of the steps that the Government promised to take was to ensure that, by 2008, all patients could have access to a genito-urinary medicine clinic within48 hours. In January this year, the hon. Member for Milton Keynes, South-West (Dr. Starkey) asked the Minister of State, Department of Health, the hon. Member for Don Valley (Caroline Flint), about the likelihood of meeting the target, and the Minister said:
	"The target is set for 2008 and we are heading for that."——[ Official Report, 31 January 2006; Vol. 442, c. 150.]
	I suppose that that was meant to indicate that the target would be met, but on 13 September, the right hon. Member for Walsall, South (Mr. George) asked the Minister of State, Department of Health, the right hon. Member for Doncaster, Central (Ms Winterton), about the same issue, and she answered that,
	"Overall, the number of attendees at GUM clinics seen within 48 hours in England increased from 45 per cent. in May 2005 to 54 per cent. in May 2006".—[ Official Report, 13 September 2006; Vol. 449, c. 2305W.]
	Is the 2008 target still expected to be met, and does the Minister have any idea whether it is likely to be met in east Yorkshire?
	I have received many representations from both constituents and professionals, which I should like to share with the House. A young woman e-mailed me to say that she had attended a family planning clinic on a Monday morning at Hessle health centre. The doctor told her that the clinic was due to be cancelled because of a lack of money. She was informed that a clinic would only be open on Monday evening and would serve the surrounding area. She said:
	"To me it is absolutely ludicrous that these clinics that are aimed at the young to prevent STDs, unwanted pregnancies and help with advice and free contraception are to be stopped."
	Local members of the British Association for Sexual Health and HIV—BASHH—said:
	"If the clients have to travel long distances they may not attend the clinic at all or may access it late with a resultant risk of morbidity to the individual and a risk of onward transmission of sexually transmitted infection, which is a public health issue."
	Another clinician who contacted me said:
	"The fact is, we are losing 11 genito-urinary sessions, mostly consultant-led and 5 family planning sessions, all doctor-led, to be replaced by 3 nurse-led...integrated clinics. There will be as yet undefined consultant GU services for complex cases...This is bound to have an impact on access, both geographically and levels of service."
	The problem for my constituents has therefore been recognised by people who work in the field. To emphasise the point, the 2005 report by the director of public health said that
	"in less than 4 years the number of cases of HIV in the East Riding has almost doubled...2005 has also seen the first female identified as HIV positive in the East Riding".
	On chlamydia, the report said:
	"Local clinics have seen a rise in incidence of more than 200 per cent. between 1995 and 2003.
	Sexually transmitted diseases, including HIV, are the greatest infectious disease challenge for the East Riding."
	However, there have been cuts in services.
	There is common thread between mental health and sexual health services. The Minister will be familiar with the Institute for Public Policy Research, a Labour-leaning organisation, which said:
	"There are compelling reasons to act. Mental health problems have a high human cost in terms of lost opportunities, poorer health and lower life expectancy."
	In the summer, the Sainsbury Centre for Mental Health said:
	"It is very worrying that mental health trusts are being squeezed to pay for the overspends of acute trusts using the new Payments by Results system. The NHS exists to bring greater fairness to health care funding and provision. It is essential to maintain that principle so that the needs of mental health service users"—
	and, indeed, sexual health service users—
	"and their families are not compromised by financial pressures elsewhere in the system."
	There is great concern across the East Riding and in my constituency of Beverley and Holderness, so I hope that the Minister can answer the points that I have put to him this evening and give local people hope that services that are too often regarded as Cinderella services will be subject to improvements, not cuts, and that the Government's mismanagement of the NHS will not continue to affect some of the most vulnerable people in society.

Ivan Lewis: No, I will not.
	The economic test proposed by the Leader of the Opposition, which would share the benefits of growth between tax cuts and spending, would result in significant cuts in expenditure on the NHS and other public services. The document that was recently presented, which suggested the level of tax cuts that the Conservative party ought to be advocating, would lead to swingeing cuts in mainstream national health services.
	It is no good Members like the hon. Member for Beverley and Holderness giving the impression to their local communities that they have supported the level of additional investment that the Government have put into the national health service so far, or that that level of funding would be continued under a Conservative Government. The hon. Gentleman does not tellhis local people that the policy of the Conservative party on health is non-intervention, operational independence and local decision making, yet he and his colleagues suggest in such debates that Ministers like me should intervene on matters such as sexual health and mental health service configuration in his locality. If we adopted the policies of the hon. Gentleman and his party, there would be total operational independence, and decisions made locally would be locally determined.
	What annoys me is not that the hon. Gentleman raises legitimate, valid and serious points in the House on behalf of his constituents, but the political disingenuousness, the posturing and the misleading presentation to his constituents of the policies of his party and the implications for the issues that he claims to care about.

Graham Stuart: I am grateful to the Minister for giving way. Perhaps he could pick up on one particular point. My constituents, and those of other hon. Members throughout the House, know that the investment bythe Labour Government has been massive. The Government, to their credit, listened, and they put the money in—but our constituents want to know where it has gone. Under this Government, productivity has fallen. Will the Minister tell us this: has productivity gone up or down? We know where the money has gone: productivity has gone down, hospitals and services are closing.